Comparison of effects of bare metal versus drug-eluting stent implantation on biomarker levels following percutaneous coronary intervention for non-ST-elevation acute coronary syndrome

被引:32
作者
Gibson, C. Michael [1 ]
Karmpaliotis, Dimitri
Kosmidou, Loanna
Murphy, Sabina A.
Kirtane, Ajay J.
Budiu, Daniela
Ray, Kausik K.
Herrmann, Howard C.
Lakkis, Nasser
Kovach, Richard.
French, William
Blankenship, James
Lui, Henry H.
Palabrica, Theresa
Jennings, Lisa K.
Cohen, David J.
Morrow, David A.
机构
[1] Harvard Univ, Brigham & Womens Hosp, Sch Med, Cardiovasc Div,TIMI Study Grp, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Dept Med, Boston, MA 02115 USA
[3] Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[4] Emory Univ, Atlanta, GA 30322 USA
[5] Univ Penn, Med Ctr, Philadelphia, PA 19104 USA
[6] Ben Taub Gen Hosp, Houston, TX 77030 USA
[7] Associated Cardiovasc Consultants New Jersey, Cherry Hill, NJ USA
[8] Harbor UCLA Med Ctr, Torrance, CA USA
[9] Geisinger Med Ctr, Danville, PA 17822 USA
[10] Apex Cardiol, Jackson, TN USA
[11] Millennium Pharmaceut Inc, Cambridge, MA USA
[12] Univ Tennessee, Nashville, TN USA
关键词
D O I
10.1016/j.amjcard.2005.12.037
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Drug-eluting stents (DESs) deliver biphasic (early and late) elution of, anti-inflammatory compounds. We therefore hypothesized that DESs would be associated with early reductions in inflammatory biomarker release after percutaneous coronary intervention (PCI). A total of 741 patients with non-ST-elevation acute coronary syndrome underwent PCI in the Randomized Trial to Evaluate the Relative PROTECTion against Post-PCI Microvascular Dysfunction and Post-PCI Ischemia among Anti-Platelet and Anti-Thrombotic Agents (PROTECT) Thrombolysis In Myocardial Infarction 30 study of eptifibatide and reduced-dose antithrombin compared with bivalirudin. Serial biomarkers C-reactive protein, troponin, creatine kinase-MB, soluble CD40 ligand, interleukin-6, prothrombin fragment F1.2, and RANTES (regulated on activation, normal T-cell expressed and secreted) were assessed through 24 hours after PCI. DES use was at the investigator's discretion. Patients treated with DESs (n = 665) versus bare metal stents (n = 139) were more likely to have patent arteries before PCI (92.0% vs 86.6%, p = 0.04), Thrombolysis In Myocardial Infarction myocardial perfusion grade 3 (57.9% vs 47.7%, p = 0.033), and the left anterior descending artery as the culprit artery (38.5% vs 18.3%, p < 0.001). The increase in C-reactive protein and troponin was lower among patients undergoing DES implantation (median 2.1 vs 3.5 mg/L for C-reactive protein, median 0.11 vs 0.41 ng/ml for troponin), even after adjustment for randomized treatment, clopidogrel before treatment, diabetes mellitus status, epicardial patency, left anterior descending artery. location, and myocardial perfusion (p = 0.036 and p = 0.039, respectively). Interleukin-6 was lower with DESs on univariate analysis but not multivariate analysis. Creatine kinase-MB, soluble sCD40 ligand, prothrombin fragment F1.2, and RANTES did not differ by DES use. In conclusion, patients undergoing DES implantation achieved more reductions in periprocedural markers of inflammation and necrosis than patients receiving bare metal stents among those with non-ST-elevation acute coronary syndrome. (c) 2006 Elsevier Inc. All rights reserved.
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收藏
页码:1473 / 1477
页数:5
相关论文
共 18 条
[1]   Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes [J].
Antman, EM ;
Tanasijevic, MJ ;
Thompson, B ;
Schactman, M ;
McCabe, CH ;
Cannon, CP ;
Fischer, GA ;
Fung, AY ;
Thompson, C ;
Wybenga, D ;
Braunwald, E .
NEW ENGLAND JOURNAL OF MEDICINE, 1996, 335 (18) :1342-1349
[2]   Atorvastatin, administered at the onset of reperfusion, and independent of lipid lowering, protects the myocardium by up-regulating a pro-survival pathway [J].
Bell, RM ;
Yellon, DM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2003, 41 (03) :508-515
[3]   In-stent stenosis: pathology and implications for the development of drug eluting stents [J].
Bennett, MR .
HEART, 2003, 89 (02) :218-224
[4]   Prognostic significance of elevated troponin I after percutaneous coronary intervention [J].
Cantor, WJ ;
Newby, LK ;
Christenson, RH ;
Tuttle, RH ;
Hasselblad, V ;
Armstrong, PW ;
Moliterno, DJ ;
Califf, RM ;
Topol, EJ ;
Ohman, EM .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (11) :1738-1744
[5]   C-REACTIVE PROTEIN INDUCES HUMAN PERIPHERAL-BLOOD MONOCYTES TO SYNTHESIZE TISSUE FACTOR [J].
CERMAK, J ;
KEY, NS ;
BACH, RR ;
BALLA, J ;
JACOB, HS ;
VERCELLOTTI, GM .
BLOOD, 1993, 82 (02) :513-520
[6]   Effect of Atorvastatin (80 mg) initiated at the time of coronary artery stent implantation on C-reactive protein and six-month clinical events [J].
Gaspardone, A ;
Versaci, F ;
Proietti, I ;
Tomai, F ;
Altamura, L ;
Skossyreva, O ;
Chiariello, L .
AMERICAN JOURNAL OF CARDIOLOGY, 2002, 90 (07) :786-+
[7]   Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs [J].
Gibson, CM ;
Cannon, CP ;
Murphy, SA ;
Ryan, KA ;
Mesley, R ;
Marble, SJ ;
McCabe, CH ;
Van de Werf, F ;
Braunwald, E .
CIRCULATION, 2000, 101 (02) :125-130
[8]   TIMI frame count: A quantitative method of assessing coronary artery flow [J].
Gibson, CM ;
Cannon, CP ;
Daley, WL ;
Dodge, JT ;
Alexander, B ;
Marble, SJ ;
McCabe, CH ;
Raymond, L ;
Fortin, T ;
Poole, WK ;
Braunwald, E .
CIRCULATION, 1996, 93 (05) :879-888
[9]   Relationship between TIMI frame count and clinical outcomes after thrombolytic administration [J].
Gibson, CM ;
Murphy, SA ;
Rizzo, MJ ;
Ryan, KA ;
Marble, SJ ;
McCabe, CH ;
Cannon, CP ;
Van de Werf, F ;
Braunwald, E .
CIRCULATION, 1999, 99 (15) :1945-1950
[10]   QUANTITATIVE ANGIOGRAPHIC AND STATISTICAL-METHODS TO ASSESS SERIAL CHANGES IN CORONARY LUMINAL DIAMETER AND IMPLICATIONS FOR ATHEROSCLEROSIS REGRESSION TRIALS [J].
GIBSON, M ;
SANDOR, T ;
STONE, PH ;
PASTERNAK, RC ;
ROSNER, B ;
SACKS, FM .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 69 (16) :1286-1290