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Lequn T, Jie F, Yongbao Z, Chengjia Q, Xinnong L, Chenyang S. Perioperative inflammatory status predicts mid-term outcomes in patients undergoing femoropopliteal paclitaxel-coated balloon angioplasty. Ann Vasc Surg 2022; 85:190-203. [PMID: 35337927 DOI: 10.1016/j.avsg.2022.02.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 02/25/2022] [Accepted: 02/27/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the association of perioperative inflammatory status, as determined using the neutrophil-to-lymphocyte ratio (NLR) and high-sensitivity C-reactive protein (hs-CRP) level, with the efficacy of femoropopliteal paclitaxel-coated balloon (PCB) angioplasty. METHODS The data of 122 patients (138 limbs) were retrospectively analyzed (median follow-up time, 21 months). The pre- and postoperative NLRs and hs-CRP levels were evaluated to determine their predictive value for mid-term primary patency and clinically driven target lesion revascularization (CD-TLR) during follow-up. Cox regression and Kaplan-Meier survival analyses were performed to investigate the predictive value of the inflammatory parameters and clinical risk factors. RESULTS The study population had a median age of 67.2±9.2 years, and 85.2±3% were men. Approximately 18.0±3% of the cases were classified under Rutherford grade II; 52.5±4%, grade III; 24.6±3%, grade IV; 4.1±1%, grade V; and 0.8±0.7%, grade VI. The 12- and 24-month cumulative patency rates were 81.2±27.0% and 60.4±30.1%, respectively, and the freedom from CD-TLR rates were 90.8±19.1% and 82.5±28.3%, respectively. Severe lesion calcification was identified as an independent risk factor for CD-TLR (hazard ratio [HR]=1.51, 95% confidence interval [CI]=1.05-3.01), while hypertension was found as a protective factor for primary patency (HR=0.54, 95% CI=0.30-0.93). The patients with Trans-Atlantic Inter-Society Consensus (TASC) C/D lesions had more than a 2-fold increased adjusted risk of both primary patency loss and CD-TLR compared with those with TASC A/B lesions (HR=2.44 for primary patency loss; HR=2.51 for CD-TLR). The perioperative NLRs and hs-CRP levels were stratified into three grades. The patients with a higher preoperative hs-CRP level (>9.2 vs. 0.6-9.2 vs. <0.6 mg/L by each tertile) had a 2.4-fold increased adjusted risk of primary patency loss compared with those with a lower preoperative hs-CRP level. The patients with a higher hs-CRP level on the first postoperative day (>13.0 vs. 7.7-13.0 vs. <7.7 mg/L by each tertile) had a 1.8-fold increased adjusted risk of primary patency loss compared with those with a lower hs-CRP level. In contrast, the patients with a higher NLR at 4-6 hours postoperatively (>3.6 vs. 2.5-3.6 vs. <2.5 by each tertile) showed better primary patency (adjusted HR=0.57) than did those with a lower NLR. A higher hs-CRP level on the first postoperative day was the only inflammatory marker associated with a high risk of CD-TLR (adjusted HR=2.37). CONCLUSION Perioperative inflammatory status serves as a valuable prognostic parameter for assessing the potential risk stratification of outcomes after PCB angioplasty.
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Affiliation(s)
- Teng Lequn
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037; Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730
| | - Fang Jie
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037
| | - Zhang Yongbao
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037
| | - Qu Chengjia
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037; Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730
| | - Liu Xinnong
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037
| | - Shen Chenyang
- National center for cardiovascular disease, Chinese Academy of Medical Sciences, Fuwai Hospital, Beijing 100037.
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Ismail HM, Abaza AO, Nasr GM, Hegazy H. High Sensitivity C-reactive Protein in Patients with Coronary Artery in-stent Restenosis: A Case-control Study. Open Cardiovasc Med J 2021. [DOI: 10.2174/1874192402115010029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Inflammation plays a pivotal role in the pathogenesis of In-Stent Restenosis (ISR). High sensitivity C-reactive protein (hsCRP) is positively associated with major cardiovascular events.
Aim:
We aimed to investigate the hsCRP inflammatory response to Percutaneous Coronary Intervention (PCI) in Coronary Artery Disease (CAD) patients with coronary ISR vs. patients without ISR.
Methods:
This case-control study included 80 CAD patients previously treated with drug-eluting stent (DES) implantation. Patients had Coronary Angiography (CAG) because of chest pain or equivalent symptoms and were subdivided into 2 groups. Group A (n=40) included CAD patients with ISR. Group B (n=40) included age and gender-matched controls with CAD but without ISR. Serum hsCRP levels were obtained before PCI (baseline) and 8, 16, 24 h post-PCI.
Results:
At baseline (before intervention/CAG), the hsCRP level was increased in the ISR group compared with the No-ISR group (p=0.007). There were 36 (90%) patients in the ISR group who had a high hsCRP (>3 mg/L) compared with 25 (62.5%) patients in the No-ISR group. Also, there was a significant relationship between high hsCRP and the ISR. Patients with ISR had higher frequencies and percentages of elevated CRP than the no-ISR control group. This difference was maintained for all measurements, baseline, after 8, 16, and 24 h (p<0.05). Repeated measures analysis of variance (ANOVA) in the ISR group revealed that mean hsCRP differed significantly between serial measurements (p<0.001). In contrast, in the control group, the mean hsCRP did not differ significantly between the serial measurements (p=0.65).
Most of our patients (n=66, 82.5%) had 1-vessel CAD disease, and the left anterior descending (LAD) coronary artery was significantly affected in 46 patients (57.5%). Management of restenosis was accomplished mainly by stenting by DES in 29 patients (72.5%).
Conclusion:
Patients with ISR had substantially higher pre- and post-PCI hsCRP levels than the no-ISR controls. This difference was maintained up to 24h post-PCI. Conversely, the mean hsCRP did not significantly differ at the follow-up points for the controls without ISR.
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Fu C, Wang H, Wei Q, He C, Zhang C. Effects of rehabilitation exercise on coronary artery after percutaneous coronary intervention in patients with coronary heart disease: a systematic review and meta-analysis. Disabil Rehabil 2018; 41:2881-2887. [PMID: 29991296 DOI: 10.1080/09638288.2018.1481148] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: The purpose of this study is to evaluate the effects of rehabilitation exercise on coronary artery of the patients with coronary heart disease (CHD) after percutaneous coronary intervention (PCI).Methods: We searched Medline, EMBASE, Cochrane CENTRAL databases, ISI Web of Science databases, Chinese Biological Medicine Data Base, Chinese knowledge resources, and Wan Fang database. Two researchers independently screened the literature databases, and assessed methodological qualities using the Physiotherapy Evidence Database scale and extracted data.Results: The coronary restenosis rate in rehabilitation exercise group was 10.8% (23/212), and that in the control group was 21% (48/229). Patients with rehabilitation exercise showed a significant reduction in restenosis rate, compared to the control group ((pooled OR: 0.46, 95% CI: 0.26-0.82, p < 0.01); heterogeneity: Chi2=3.86, df =5 (p = 0.57); I2=0%). In addition, the late luminal loss per stent in the rehabilitation exercise group was significantly smaller than that in the control group ((pooled MD: -0.33, 95% CI: -0.52 to -0.13, p < 0.01); heterogeneity: Chi2=0.27, df =1 (p = 0.60); I2=0%).Conclusions: Appropriate rehabilitation exercise reduces the incidence of coronary restenosis after PCI in patients with CHD and contributes to a significant reduction in late luminal loss in the stented coronary segment.Implications for RehabilitationAppropriate rehabilitation exercise can reduce the incidence of coronary restenosis after percutaneous coronary intervention in patients with coronary heart disease.Appropriate rehabilitation exercise contributes to a reduction in late luminal loss in the stented coronary segment.
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Affiliation(s)
- Chenying Fu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan, China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China
| | - Haiming Wang
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China.,Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Quan Wei
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China.,Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chengqi He
- Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, PR China.,Department of Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, Sichuan, PR China
| | - Chi Zhang
- Department of Rehabilitation Medicine Center, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, PR China
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Ohtake T, Mochida Y, Matsumi J, Tobita K, Ishioka K, Oka M, Maesato K, Moriya H, Hidaka S, Saito S, Kobayashi S. Beneficial Effect of Endovascular Therapy and Low-Density Lipoprotein Apheresis Combined Treatment in Hemodialysis Patients With Critical Limb Ischemia due to Below-Knee Arterial Lesions. Ther Apher Dial 2016; 20:661-667. [DOI: 10.1111/1744-9987.12450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 03/13/2016] [Accepted: 05/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Takayasu Ohtake
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Yasuhiro Mochida
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Junya Matsumi
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kazuki Tobita
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kunihiro Ishioka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Machiko Oka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Kyoko Maesato
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Hidekazu Moriya
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Sumi Hidaka
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shigeru Saito
- Department of Cardiology and Catheterization; Shonan Kamakura General Hospital; Kamakura Japan
| | - Shuzo Kobayashi
- Department of Nephrology, Immunology, and Vascular Medicine, Kidney and Dialysis Center; Shonan Kamakura General Hospital; Kamakura Japan
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Golukhova EZ, Grigorian MV, Ryabinina MN, Bulaeva NI, Fortmann S, Serebruany VL. Independent Predictors of Major Adverse Events following Coronary Stenting over 28 Months of Follow-Up. Cardiology 2015; 132:176-81. [DOI: 10.1159/000435909] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 06/10/2015] [Indexed: 11/19/2022]
Abstract
Background: Despite recent advances in stent design and constantly improving protective pharmacological strategies, complications and adverse events following percutaneous coronary interventions (PCI) are still major factors influencing morbidity and mortality. Therefore, predicting secondary vascular occlusions represents an unmet medical need. Objective: The aim of our study was to triage clinical and laboratory predictors of major adverse clinical events (MACE) following coronary stenting. Methods: This was a prospective, case-controlled, single-center study, which included 94 consecutive patients with documented coronary disease who underwent PCI with drug-eluting stent (DES) implantation. All patients received dual antiplatelet therapy with aspirin and clopidogrel. Numerous clinical characteristics and laboratory biomarkers were assessed before stenting and were correlated with poststenting MACE over the mean follow-up of 28 months. MACE included death, nonfatal myocardial infarction, target vessel revascularisation, stroke, stent thrombosis, angina recurrence and instent restenosis. Results: Twenty-three patients experienced MACE. Independent MACE predictors after PCI with DES implantation were antecedent diabetes mellitus (RR = 0.45; 95% CI 0.20-0.97; p = 0.045), prior thrombolytic therapy (RR = 0.42; 95% CI 0.27-0.83; p = 0.039), baseline plasminogen activator inhibitor -1 (PAI-1; p = 0.008) and plasma von Willebrand factor (vWF) activity (p = 0.007). Other clinical characteristics and laboratory indices showed no correlation with MACE. Conclusions: Background diabetes mellitus, prior thrombolytic therapy, PAI-1 and vWF prestenting activity may be useful for MACE prediction over 28 months of follow-up.
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Hamann L, Glaeser C, Schulz S, Gross M, Franke A, Nöthlings U, Schumann RR. A micro RNA-146a polymorphism is associated with coronary restenosis. Int J Immunogenet 2014; 41:393-6. [PMID: 25053223 DOI: 10.1111/iji.12136] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/09/2014] [Accepted: 06/12/2014] [Indexed: 02/06/2023]
Abstract
The association of the miRNA-146a polymorphism rs2910164 with atherosclerosis and restenosis was investigated. We found no association with atherosclerosis; however, we found a negative association for the G/C (P = 0.007) and a positive association for the C/C genotype with the risk of restenosis, which is the main drawback for cardiac surgery.
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Affiliation(s)
- L Hamann
- Institute of Microbiology and Hygiene, Charité University Medical Center, Berlin, Germany
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7
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Choi HE, Lee BJ, Kim C. Impact of exercise-based cardiac rehabilitation on de novo coronary lesion in patients with drug eluting stent. Ann Rehabil Med 2014; 38:256-62. [PMID: 24855621 PMCID: PMC4026613 DOI: 10.5535/arm.2014.38.2.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 10/01/2013] [Indexed: 12/02/2022] Open
Abstract
Objective To compare the rate of progression of de novo lesion between the cardiac rehabilitation (CR) and control groups. Methods This is a retrospective observational study. Patients who received drug-eluting stent (DES) due to acute coronary syndrome were included as subjects. The CR group received eight weeks of early CR program, and sustained a self-exercise program in the homes. The control group was instructed to exercise independently. Nine months after the first insertion of DES, we implemented follow-up coronary angiography, and compared the rate of progression of de novo lesion by quantitative angiographic measurement between the two groups. Results A total of 81 patients were recruited as subjects to CR group (n=32) or control group (n=49). At nine months, late luminal loss was 0.04±0.23 mm in the CR group and 0.00±0.31 mm in the control group (p=0.54, observed power=0.10). Late loss was -0.90%±9.53% in the CR group and 0.80%±11.15% in the control group (p=0.58, observed power=0.05). No target lesion revascularization procedures were needed in the CR group, while two in the control group (p=0.25). In the CR group, mean VO2max was significantly improved from 24.36±5.00 to 27.68±5.24 mL/kg/min (p<0.001). Conclusion We could not observe a statistically significant difference in the progression rate of de novo lesion between the CR and control groups. Thus the current amount of nine months exercise-based CR program does not seem to have a distinct impact on the retardation of de novo coronary lesion in patients who received percutaneous coronary intervention with DES.
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Affiliation(s)
- Hee Eun Choi
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Byeong Ju Lee
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Chul Kim
- Department of Rehabilitation Medicine, Inje University Sanggye Paik Hospital, Seoul, Korea
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Comparative prognostic value of low-density lipoprotein cholesterol and C-reactive protein in patients with stable coronary artery disease treated with percutaneous coronary intervention and chronic statin therapy. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:131-6. [PMID: 24630704 DOI: 10.1016/j.carrev.2014.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 02/11/2014] [Accepted: 02/20/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND The comparative prognostic value of low density lipoprotein-cholesterol (LDL-C) and C-reactive protein (CRP) in patients with stable coronary artery disease (CAD) treated with percutaneous coronary intervention (PCI) and statin therapy is poorly investigated. METHODS The study included 7595 patients with stable CAD treated with PCI. Based on a cut-off of 100mg/dl for LDL-C and 3mg/L for CRP, patients were divided into 4 groups: patients with LDL-C≤100mg/dl and CRP≤3mg/L (n=2795); patients with LDL-C>100mg/dl and CRP≤3mg/L (n=2091); patients with LDL-C≤100mg/dl and CRP>3mg/L (n=1296); and patients with LDL-C>100mg/dl and CRP>3mg/L (n=1413). Statins at discharge were prescribed in all patients. The primary outcome was 1-year all-cause mortality. RESULTS One-year mortality was 2.1% (160 deaths): 1.2% (33 deaths) among patients with LDL-C ≤100mg/dl and CRP≤3mg/L, 1.4% (28 deaths) among patients with LDL-C>100mg/dl and CRP≤3mg/L, 4.8% (60 deaths) among patients with LDL-C≤100mg/dl and CRP>3mg/L and 2.9% (39 deaths) among patients with LDL-C>100mg/dl and CRP>3mg/L (P<0.001). After adjustment, CRP (hazard ratio [HR]=1.64, 95% confidence interval [CI] 1.33-2.02, for 1 standard deviation increase in the logarithmic scale) but not LDL-C (HR=1.03 [0.90-1.17], for 30mg/dl increase) showed an independent association with 1-year mortality. CRP (P=0.045) but not LDL-C (P=0.294) increased the discriminatory power of multivariable model for prediction of mortality. CONCLUSION In patients with stable CAD treated with PCI and statin therapy, CRP but not LDL-C was independently associated with increased risk of 1-year mortality.
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Hamann L, Koch A, Sur S, Hoefer N, Glaeser C, Schulz S, Gross M, Franke A, Nöthlings U, Zacharowski K, Schumann RR. Association of a common TLR-6 polymorphism with coronary artery disease - implications for healthy ageing? IMMUNITY & AGEING 2013; 10:43. [PMID: 24498948 PMCID: PMC4028875 DOI: 10.1186/1742-4933-10-43] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/23/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND The pro-inflammatory status of the elderly triggers most of the age-related diseases such as cancer and atherosclerosis. Atherosclerosis, the leading cause world wide of morbidity and death, is an inflammatory disease influenced by life-style and genetic host factors. Stimuli such as oxLDL or microbial ligands have been proposed to trigger inflammation leading to atherosclerosis. It has recently been shown that oxLDL activates immune cells via the Toll-like receptor (TLR) 4/6 complex. Several common single nucleotide polymorphisms (SNPs) of the TLR system have been associated with atherosclerosis. To investigate the role of TLR-6 we analyzed the association of the TLR-6 SNP Pro249Ser with atherogenesis. RESULTS Genotyping of two independent groups with CAD, as well as of healthy controls revealed a significant association of the homozygous genotype with a reduced risk for atherosclerosis (odds ratio: 0.69, 95% CI 0.51-0.95, P = 0.02). In addition, we found a trend towards an association with the risk of restenosis after transluminal coronary angioplasty (odds ratio: 0.53, 95% CI 0.24-1.16, P = 0.12). In addition, first evidence is presented that the frequency of this protective genotype increases in a healthy population with age. Taken together, our results define a role for TLR-6 and its genetic variations in modulating the inflammatory response leading to atherosclerosis. CONCLUSIONS These results may lead to a better risk stratification, and potentially to an improved prophylactic treatment of high-risk populations. Furthermore, the protective effect of this polymorphism may lead to an increase of this genotype in the healthy elderly and may therefore be a novel genetic marker for the well-being during aging.
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Affiliation(s)
- Lutz Hamann
- Institute for Microbiology and Hygiene, Charité University Medical Center, Hindenburgdamm 27, 12003 Berlin, Germany.
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Hudzik B, Szkodzinski J, Pietka-Rzycka A, Danikiewicz A, Wojnar R, Lekston A, Polonski L, Zubelewicz-Szkodzinska B. Plasma Pentraxin 3 May Be a More Sensitive Marker of Inflammatory Response Than High-Sensitivity C-Reactive Protein After Bare-Metal Stent Compared to Drug-Eluting Stent Implantation. J Interferon Cytokine Res 2013; 33:280-4. [DOI: 10.1089/jir.2012.0023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bartosz Hudzik
- 3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Janusz Szkodzinski
- 3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | | | | | - Rafal Wojnar
- 3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Andrzej Lekston
- 3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Lech Polonski
- 3rd Department of Cardiology, Silesian Center for Heart Disease, Medical University of Silesia, Zabrze, Poland
| | - Barbara Zubelewicz-Szkodzinska
- Division of Endocrinology, Municipal Hospital, Piekary Slaskie, Poland
- Department of Human Nutrition, Medical University of Silesia, Bytom, Poland
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Bugiardini R, Eskola M, Huhtala H, Niemelä K, Karhunen P, Miglio R, Manfrini O, Pizzi C, Nikus K. Coronary revascularisation in stable patients after an acute coronary syndrome: a propensity analysis of early invasive versus conservative management in a register-based cohort study. BMJ Open 2013; 3:bmjopen-2013-002559. [PMID: 23616436 PMCID: PMC3641503 DOI: 10.1136/bmjopen-2013-002559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES To compare the effectiveness of in-hospital medical therapy versus coronary revascularisation added to medical therapy in patients who stabilised after an acute coronary syndrome (ACS). DESIGN Propensity score-matched cohort study from the database of the Tampere ACS registry. SETTING A single academic hospital in Finland. PARTICIPANTS 1149 patients with a recent ACS, but no serious coexisting conditions: recurrent ischaemic episodes despite adequate medical therapy, haemodynamic instability, overt congestive heart failure and serious ventricular arrhythmias. PRIMARY AND SECONDARY OUTCOME MEASURES The composite endpoint of major acute cardiovascular events (MACEs): unstable angina requiring rehospitalisation, stroke, myocardial infarction and all-cause mortality, at 6-month follow-up. RESULTS Compared with standard medical treatment, revascularisation was associated with a lower rate of MACEs at 6 months in patients of the first quintile (HR 0.81; 95% CI 0.66 to 0.99), but a higher rate of MACEs in the fifth quintile (HR 4.74, CI 1.36 to 16.49; p=0.014). There were no significant differences in the rates of MACEs in the remaining three quintiles. Patients of the first quintile were the oldest (79.7±8.3 years) and had a more significant (p<0.001) history of prior myocardial infarction (37%) and poor renal function (creatine, µmol/l: 114.9±70.7). They also showed the highest C reactive protein (7.3±9.5 mg/l) levels. CONCLUSIONS Our findings suggest that in-hospital coronary revascularisation did not lead to any advantage with signal of possible harm in the great majority of patients who stabilised after an ACS. An early invasive management strategy may be best reserved for elderly patients having high-risk clinical features and biochemical evidence of a strong inflammatory activity.
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Affiliation(s)
- Raffaele Bugiardini
- Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Markku Eskola
- Heart Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Heini Huhtala
- School of Public Health, University of Tampere, Tampere, Finland
| | - Kari Niemelä
- Heart Center, Pirkanmaa Hospital District, Tampere, Finland
| | - Pekka Karhunen
- Medical School, University of Tampere, and Research Unit of Laboratory Centre, Tampere, Finland
| | - Rossella Miglio
- Statistical Sciences “Paolo Fortunati”, University of Bologna, Bologna, Italy
| | - Olivia Manfrini
- Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Experimental, Diagnostic and Speciality Medicine, University of Bologna, Bologna, Italy
| | - Kjell Nikus
- Heart Center, Pirkanmaa Hospital District, Tampere, Finland
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Gasper WJ, Owens CD, Kim JM, Hills N, Belkin M, Creager MA, Conte MS. Thirty-day vein remodeling is predictive of midterm graft patency after lower extremity bypass. J Vasc Surg 2012; 57:9-18. [PMID: 22960020 DOI: 10.1016/j.jvs.2012.06.098] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Revised: 06/15/2012] [Accepted: 06/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Successful adaptation of a vein graft to an arterial environment is incompletely understood. We sought to investigate whether early vein graft remodeling is predictive of subsequent patency. METHODS A prospective longitudinal study was conducted of 67 patients undergoing lower extremity bypass with autogenous vein between February 2004 and April 2008. Preoperative blood samples were drawn for biomarkers. During the bypass operation, a 5-cm index segment of the graft was registered for serial lumen diameter measurements at 0, 1, 3, 6, 9, and 12 months using duplex ultrasound imaging. The imaging substudy analysis included patients with at least two ultrasound assessments. RESULTS Patients (55% male) were a median age of 70 years (interquartile range [IQR], 59-76 years), 40% had diabetes mellitus, 49% had critical limb ischemia, 75% were taking a statin, and 91% were taking an antiplatelet medication. Median follow-up was 32 months (IQR, 15-47 months). The median baseline high-sensitivity C-reactive protein level (hsCRP) was 3.2 mg/L (IQR, 1.4-9.7 mg/L). The average intraoperative, postimplantation vein lumen diameter was 3.9±1.0 mm, increasing to 4.7±1.1 mm at 1 month, an average 24%±27% change per patient. By 3 months, the average lumen diameter was 5.1±1.6 mm, with little subsequent change observed to 12 months. Nonwhite race, baseline hsCRP ≥5 mg/L, statin use, and initial lumen diameter were significantly associated with early (0- to 1-month) vein remodeling in a multivariable regression model. The primary patency rate for the cohort was 60%±6.3% at 2 years. Initial lumen diameter of the index segment was not associated with primary patency, whereas larger lumen diameter achieved at 1 month (≥5.1 mm) was positively associated with primary patency (log-rank, P=.03). Early (30-day) remodeling behavior was used to divide patients into "poor remodelers" (<-5% lumen diameter change, n=6), "modest remodelers" (-5% to 25% change, n=29), and "robust remodelers" (>+25% change, n=30). Early remodeling category was significantly associated with primary patency rate at 2 years (log-rank, P=.02). A multivariable Cox proportional hazards model showed that modest remodelers (hazard ratio, 3.9; 95% confidence interval, 1.02-15; P=.04) and poor remodelers (hazard ratio, 13; 95% confidence interval; P=.008) had significantly higher hazard ratios for graft failure than robust early remodelers. CONCLUSIONS Early remodeling of the arterialized vein appears to predict midterm bypass graft patency. In addition to baseline diameter, race, inflammation, hsCRP, and statin use are associated with early adaptive remodeling, but the mechanisms for these observations are not understood.
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Affiliation(s)
- Warren J Gasper
- Division of Vascular and Endovascular Surgery, Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA 94143-0222, USA
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13
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Kim C, Choi HE, Kim BO, Lim MH. Impact of Exercise-based Cardiac Rehabilitation on In-stent Restenosis with Different Generations of Drug Eluting Stent. Ann Rehabil Med 2012; 36:254-61. [PMID: 22639751 PMCID: PMC3358683 DOI: 10.5535/arm.2012.36.2.254] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 02/23/2012] [Indexed: 11/05/2022] Open
Abstract
Objective To compare the rate of restenosis between a cardiac rehabilitation (CR) group and a control group within three different generations of drug eluting stents (DES). Method Patients who received DES due to an acute coronary syndrome were included. They were divided into a CR group and a control group. The CR group received six to eight weeks of early cardiac rehabilitation program in a hospital setting, and sustained a self-exercise program for six months in a community. The control group was instructed to exercise by themselves after leaving the hospital. Nine months after the first onset of disease, we implemented a coronary angiography and compared the two groups. In addition, we divided the patients into three subgroups according to the generation of DES, and compared the rate of restenosis between the CR group and control group within these three subgroups. Results At 9 months, in-stent restenosis, measured as an in-segment late luminal loss (LLL) of the stented coronary area, was smaller in the CR group (n=52) 0.16±0.42 mm compared to the control group (n=51) 0.39±0.78 mm (p<0.05). A reduction of LLL in the CR group compared to the control group was consistent among the three different generations of DES. Conclusion The CR program is strongly associated with a significant reduction in LLL in the stented coronary segments, regardless of the generation of DES.
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Affiliation(s)
- Chul Kim
- Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 139-707, Korea
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14
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Abstract
The pathophysiology of post-PCI restenosis involves neointimal formation that consists of three phases: thrombosis (within 24 h), recruitment (3-8 days), and proliferation, which starts on day 8 of PCI. Various factors suggested to be predictors/risks for restenosis include C-reactive protein (CRP), inflammatory mediators (cytokines and adhesion molecules), oxygen radicals, advanced glycation end products (AGEs) and their receptors (RAGE), and soluble RAGE (sRAGE). The earlier noted factors produce thrombogenesis, vascular smooth muscle cell proliferation, and extracellular matrix formation. Statins have pleiotropic effects. Besides lowering serum cholesterol, they have various other biological effects including antiinflammatory, antithrombotic, CRP-lowering, antioxidant, antimitotic, and inhibition of smooth muscle cell proliferation. They inhibit matrix metalloproteinase and cyclooxygenase-2, lower AGEs, decrease expression of RAGE and increase levels of serum sRAGE. They also increase the synthesis of nitric oxide (NO) by increasing endothelial NO synthase expression and activity. Preprocedural statin therapy is known to reduce peri- and post-PCI myonecrosis and reduce the need for repeat revascularization. There is evidence that statin-eluting stents inhibit in-stent restenosis in animal models. It is concluded that because of the above attributes of statins, they are suitable candidates for reduction of post-PCI restenosis and post-PCI myonecrosis. The future directions for the use of statins in reduction of post-PCI restenosis and myonecrosis have been discussed.
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Affiliation(s)
- Kailash Prasad
- Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
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15
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Shi JZ, Wang LY, Zhu Y, Zhao CY, Liu W, Jiang SL, You HW, Wang Y, Xu FY, Tang YS, Cui LQ. OX40 Ligand Levels and High-Sensitivity C-Reactive Protein Levels in Blood from Local Coronary Plaque and the Femoral Artery in Patients with Acute Coronary Syndrome or Stable Angina. J Int Med Res 2011; 39:1275-83. [PMID: 21986129 DOI: 10.1177/147323001103900415] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OX40 ligand (OX40L) and high-sensitivity C-reactive protein (hs-CRP) play important roles in the pathogenesis of atherosclerosis. In this study, consecutive patients with acute coronary syndrome (ACS; n = 90) or stable angina (SA; n = 40) and healthy control subjects ( n = 50) were evaluated to assess plasma OX40L and serum hs-CRP levels in local coronary plaque and the femoral artery. OX40L and hs-CRP levels in the femoral artery were significantly higher in patients with ACS compared with controls. OX40L and hs-CRP levels in local coronary plaque (OX40Lc and hs-CRPc, respectively) were significantly higher in ACS than in SA patients. OX40L and hs-CRP levels were positively correlated with each other and were also correlated with fibrinogen levels. The number of complex lesions was correlated with OX40Lc and hs-CRPc levels. It is concluded that the OX40Lc level was highly sensitive for evaluating the inflammatory response in ACS and elevated levels of OX40Lc may be a valuable predictive marker for increased risk of atherosclerotic progression in ACS patients.
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Affiliation(s)
- JZ Shi
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - LY Wang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Y Zhu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - CY Zhao
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - W Liu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - SL Jiang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - HW You
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - Y Wang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - FY Xu
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - YS Tang
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
| | - LQ Cui
- Department of Cardiology, Provincial Hospital affiliated to Shandong University, Jinan, China
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Munk PS, Breland UM, Aukrust P, Ueland T, Kvaløy JT, Larsen AI. High intensity interval training reduces systemic inflammation in post-PCI patients. ACTA ACUST UNITED AC 2011; 18:850-7. [PMID: 21450602 DOI: 10.1177/1741826710397600] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increased plasma levels of inflammatory markers and markers of endothelial cell activation have been associated with increased risk for cardiovascular events. Exercise training may lower the risk for coronary heart disease by attenuating inflammation and improving endothelial function. The objective of this study was to evaluate effects of regular high-intensity exercise training on a wide range of markers of inflammation and endothelial cell activation. MATERIALS AND METHODS Consecutively, 40 patients were prospectively randomized to a 6 months supervised high-intensity interval training programme or to a control group following successful percutaneous coronary intervention (PCI). Blood samples of 36 patients with stable angina, drawn at baseline (before PCI) and at 6 months, were analysed. Late luminal loss was measured at 6 months using quantitative coronary angiography. RESULTS At 6 months, levels of the inflammatory markers interleukin (IL)-6 and IL-8 were reduced and levels of the anti-inflammatory cytokine IL-10 increased in the training group only. The decrease in IL-6 and C-reactive protein levels were significantly correlated with the decrease in luminal loss following PCI. In contrast to these anti-inflammatory effects, training had no effect on markers of platelet-mediated inflammation, and the effect of training on markers on endothelial cell activation were rather complex showing attenuating (von Willebrand factor) and enhancing (E-selectin and vascular cell adhesion molecule 1) effects. CONCLUSIONS Regular exercise training in stable angina patients following PCI may attenuate some, but not all, inflammatory pathways, potentially contributing to the beneficial effects of exercise training on restenosis.
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Affiliation(s)
- Peter Scott Munk
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway.
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17
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Sarov-Blat L, Morgan JM, Fernandez P, James R, Fang Z, Hurle MR, Baidoo C, Willette RN, Lepore JJ, Jensen SE, Sprecher DL. Inhibition of p38 mitogen-activated protein kinase reduces inflammation after coronary vascular injury in humans. Arterioscler Thromb Vasc Biol 2010; 30:2256-63. [PMID: 20689074 DOI: 10.1161/atvbaha.110.209205] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate whether a p38α/β mitogen-activated protein kinase inhibitor, SB-681323, would limit the elevation of an inflammatory marker, high-sensitivity C-reactive protein (hsCRP), after a percutaneous coronary intervention (PCI). METHODS AND RESULTS Coronary artery stents provide benefit by maintaining lumen patency but may incur vascular trauma and inflammation, leading to myocardial damage. A key mediator for such stress signaling is p38 mitogen-activated protein kinase. Patients with angiographically documented coronary artery disease receiving stable statin therapy and about to undergo PCI were randomly selected to receive SB-681323, 7.5 mg (n=46), or placebo (n=46) daily for 28 days, starting 3 days before PCI. On day 3, before PCI, hsCRP was decreased in the SB-681323 group relative to the placebo group (29% lower; P=0.02). After PCI, there was a statistically significant attenuation in the increase in hsCRP in the SB-681323 group relative to the placebo group (37% lower on day 5 [P=0.04]; and 40% lower on day 28 [P=0.003]). There were no adverse safety signals after 28 days of treatment with SB-681323. CONCLUSIONS In the setting of statin therapy, SB-681323 significantly attenuated the post-PCI inflammatory response, as measured by hsCRP. This inflammatory dampening implicates p38 mitogen-activated protein kinase in the poststent response, potentially defining an avenue to limit poststent restenosis.
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Affiliation(s)
- Lea Sarov-Blat
- Heart Failure Discovery Performance Unit, Metabolic Pathways Center of Excellence for Drug Discovery, GlaxoSmithKline, 709 Swedeland Rd, UW2301, King of Prussia, PA 19406, USA
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18
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Inflammatory response to percutaneous coronary intervention in stable coronary artery disease. J Thromb Thrombolysis 2010; 31:92-8. [DOI: 10.1007/s11239-010-0471-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Norhammar A, Lagerqvist B, Saleh N. Long-term mortality after PCI in patients with diabetes mellitus: results from the Swedish Coronary Angiography and Angioplasty Registry. EUROINTERVENTION 2010. [DOI: 10.4244/eijv5i8a152] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Saleh N, Kovacs A, Tornvall P. Relevance of genetic polymorphisms in inflammatory response to percutaneous coronary intervention. Scandinavian Journal of Clinical and Laboratory Investigation 2009; 69:736-40. [DOI: 10.3109/00365510903100466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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21
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Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation A randomized controlled trial evaluating the relationship to endothelial function and inflammation. Am Heart J 2009; 158:734-41. [PMID: 19853690 DOI: 10.1016/j.ahj.2009.08.021] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Accepted: 08/21/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND High-intensity interval training has been shown to be superior to moderate continuous exercise training in improving exercise capacity and endothelial function in patients with coronary artery disease. The objective of this study was to evaluate this training model on in-stent restenosis following percutaneous coronary intervention for stable or unstable angina. METHODS AND RESULTS We prospectively randomized 40 patients after percutaneous coronary intervention with implantation of a bare metal stent (n = 30) or drug eluting stent (n = 32) to a 6-month supervised high-intensity interval exercise training program (n = 20) or to a control group (n = 20). At six months, restenosis, measured as in-segment late luminal loss of the stented coronary area, was smaller in the training group 0.10 (0.52) mm compared to the control group 0.39 (0.38) mm (P = .01). Reduction of late luminal loss in the training group was consistent with both stent types. Peak oxygen uptake increased in the training and control group by 16.8% and 7.8%, respectively (P < .01). Flow-mediated dilation improved 5.2% (7.6) in the training group and decreased -0.1% (8.1) in the control group (P = .01). Levels of high-sensitivity C-reactive protein decreased by -0.4 (1.1) mg/L in the training group and increased by 0.1 (1.2) mg/L in the control group (P = .03 for trend). CONCLUSIONS Regular high-intensity interval exercise training was associated with a significant reduction in late luminal loss in the stented coronary segment. This effect was associated with increased aerobic capacity, improved endothelium function, and attenuated inflammation.
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Affiliation(s)
- Peter S Munk
- Department of Cardiology, Stavanger University Hospital, Norway.
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22
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Park MW, Seung KB, Kim PJ, Park HJ, Yoon SG, Baek JY, Koh YS, Jung HO, Chang K, Kim HY, Baek SH. Long-term percutaneous coronary intervention rates and associated independent predictors for progression of nonintervened nonculprit coronary lesions. Am J Cardiol 2009; 104:648-52. [PMID: 19699339 DOI: 10.1016/j.amjcard.2009.04.052] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2008] [Revised: 04/14/2009] [Accepted: 04/14/2009] [Indexed: 10/20/2022]
Abstract
After successful percutaneous coronary intervention (PCI), unpredictable coronary events occur that are caused by in-stent restenosis and the progression of preexisting nonculprit coronary lesions. However, little is known about the long-term clinically driven PCI rates for the progression of nonculprit coronary lesions discovered during culprit-lesion PCI or its independent predictors, including several biomarkers. In this study, the clinical and angiographic data of 1,395 PCI patients treated from January 2004 to May 2007 were retrospectively analyzed. Of these patients, 507 were eligible for this study. After baseline PCI (i.e., culprit-lesion PCI), 81 patients (16%) underwent additional clinically driven PCI to treat preexisting nonculprit coronary lesions during the study period. The cumulative rates of clinically driven PCI for nonculprit coronary lesions were 7.7% (n = 39) at 1 year, 14% (n = 70) at 2 years, and 16% (n = 81) at 3 years. The independent predictors of clinically driven PCI included a larger number of significant coronary lesions (odds ratio [OR] 2.29, 95% confidence interval [CI] 1.5 to 3.5, p <0.001), low high-density lipoprotein (<40 mg/dl; OR 2.01, 95% CI 1.01 to 3.98, p = 0.046), hypercholesterolemia (total cholesterol >200 mg/dl; OR 1.46, 95% CI 1.22 to 1.97, p = 0.04), history of PCI (OR 1.24, 95% CI 1.09 to 1.60, p = 0.003), and increased triglyceride levels (OR 1.003, 95% CI 1.001 to 1.007, p = 0.038) at the time of baseline PCI. In conclusion, PCI patients with nonculprit coronary lesions underwent additional clinically driven PCI at rates of 7.7% at 1 year, 14% at 2 years, and 16% at 3 years because of the progression of preexisting nonculprit coronary lesions. Overall coronary artery disease burden and poor lipid profiles at baseline PCI confer significant risks for clinically driven PCI.
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Razzouk L, Muntner P, Bansilal S, Kini AS, Aneja A, Mozes J, Ivan O, Jakkula M, Sharma S, Farkouh ME. C-reactive protein predicts long-term mortality independently of low-density lipoprotein cholesterol in patients undergoing percutaneous coronary intervention. Am Heart J 2009; 158:277-83. [PMID: 19619706 DOI: 10.1016/j.ahj.2009.05.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2009] [Accepted: 05/25/2009] [Indexed: 01/03/2023]
Abstract
BACKGROUND Few data are available on the association of high-sensitivity C-reactive protein (hs-CRP) and mortality independent of low-density lipoprotein (LDL) cholesterol in patients undergoing percutaneous coronary intervention (PCI). METHODS Consecutive patients (N = 8,834) undergoing PCI between October 28, 2002, and December 31, 2006, were followed through June 30, 2007 (average and maximum follow-up of 1.9 and 4.6 years, respectively). High-sensitivity CRP levels were classified into 4 groups: <1.0, 1.0 to 2.9, 3.0 to 9.9, and > or =10 mg/L. RESULTS All-cause mortality rates were 14.4, 17.5, 25.7, and 56.4 per 1,000 person-years in patients with hs-CRP levels of <1.0, 1.0 to 2.9, 3.0 to 9.9, and > or =10 mg/L, respectively. Compared with patients with hs-CRP <1.0 mg/L, the hazard ratios of mortality after multivariable adjustment, including LDL cholesterol, associated with hs-CRP levels of 1.0 to 2.9, 3.0 to 9.9, and > or =10 mg/L were 1.27 (95% CI 0.91-1.75), 1.70 (95% CI 1.26-2.29), and 2.99 (95% CI 2.24-3.99), respectively (P trend < .001). After multivariable adjustment, trends of higher all-cause mortality at higher hs-CRP were present for patients with LDL cholesterol <70, 70 to 99, and > or =100 mg/dL (each P < .001). A test for interaction between LDL cholesterol and hs-CRP on all-cause mortality was not significant (P = .30). CONCLUSIONS High-sensitivity CRP levels provide significant incremental prognostic information for all-cause mortality in long-term follow-up independent of LDL cholesterol.
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Affiliation(s)
- Louai Razzouk
- Cardiac Catheterization Laboratory and Clinical Trials Unit, Cardiovascular Institute, Mount Sinai Heart, New York, NY, USA
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24
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Jimenez-Valero S, Moreno R, Sanchez-Recalde A, Galeote G, Calvo L, Viana A, Lopez de Sá E, López-Sendón J. Avoiding restenosis: is there a role for glucocorticoids in the drug-eluting stent era? Ther Adv Cardiovasc Dis 2009; 2:137-46. [PMID: 19124417 DOI: 10.1177/1753944708090573] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Restenosis is an important limitation of percutaneous coronary interventions (PCI). In-stent restenosis is mainly due to neointimal hyperplasia, a proliferative process modulated by inflammatory mechanisms. Numerous technical and pharmacological means have been tested to reduce restenosis rates, with frequently disappointing clinical results. Drug-eluting stents (DES) have demonstrated a high efficacy in reducing restenosis, but there are some associated problems that limit its generalized utilization. Glucocorticoids (GC), as potent anti-inflammatory agents, may exert beneficial effects on neointimal proliferation. Clinical studies with oral and intracoronary GC therapy have demonstrated reduction in restenosis rates in selected patients. Although further investigations are warranted, GC might have a potential role for restenosis prevention in selected cases.
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Impact of direct sirolimus-eluting stent implantation on the early systemic inflammatory response compared with complementary stent implantation. Coron Artery Dis 2009; 20:65-70. [PMID: 19018239 DOI: 10.1097/mca.0b013e32830d27bd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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High sensitive C-reactive protein, adiponectin, and urine albumin excretion rate in Chinese coronary artery disease patients with different glucose tolerance status. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200812020-00008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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27
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Comparison of changes in early inflammatory markers between sirolimus- and paclitaxel-eluting stent implantation. Cardiovasc Drugs Ther 2008; 23:137-43. [PMID: 19016317 DOI: 10.1007/s10557-008-6149-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 10/17/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Systemic inflammation after coronary intervention identifies patients at increased risk of subsequent cardiac events. Cardiac events, especially in-stent restenosis, are less frequent after use of sirolimus-eluting stent (SES) compared with paclitaxel-eluting stent (PES). However, the underlying mechanism for this disparity is not well investigated. We hypothesize that an attenuated inflammatory response after SES implantation may be a contributor. PURPOSE In the present study, we sought to determine the early inflammatory response after SES implantation in patients with single-vessel disease compared with PES implantation, and evaluate the relationship between inflammatory response and late clinical outcomes in a randomized design. METHODS Thirty-two patients with stable angina were randomly enrolled into the two groups, SES or PSE group (n = 16 respectively). Peripheral blood samples were taken before PCI, 24 and 72 h after stenting. The plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined by enzyme-linked immunosorbent assay (ELISA). The clinical and angiographic follow-up was performed at 8 months after stenting. RESULTS The data showed that there was no significant difference in clinical and angiographic baseline characteristics between the two groups. The plasma CRP and IL-6 levels at 24 h after stenting were significant higher in both groups compared with baseline (p < 0.01 respectively). Likewise, the CRP levels at 72 h after stenting were also significant higher compared with baseline in both groups (p < 0.01 respectively). However, the plasma levels of IL-6 at 24 h and CRP at 72 h after stenting were higher in PES group compared with SES group (p < 0.05). At 8 months follow-up, the rates of major adverse cardiac events, target lesion revascularization, in-stent and in-segment restenosis were similar in both groups. However, the late loss in both in-stent and in-segment was significantly higher in the PES group than in SES group (p < 0.001 respectively). CONCLUSIONS Our findings suggest that a drug-eluting stent implantation could trigger a systemic inflammatory response as previously demonstrated. However, SES implantation results in a lower inflammatory response compared with PES implantation, which seems to be associated with greater late of in-stent and in-segment loss at 8-month follow-up with PES.
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Li JJ, Qin XW, Yang XC, Li ZC, Zeng HS, Xu B, Gao Z, Wu YJ, Zhang X, Zhang CY. Randomized comparison of early inflammatory response after sirolimus-eluting stent vs bare metal stent implantation in native coronary lesions. Clin Chim Acta 2008; 396:38-42. [PMID: 18634770 DOI: 10.1016/j.cca.2008.06.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2007] [Revised: 05/15/2008] [Accepted: 06/19/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The clinical significance of early inflammatory response after coronary stent implantation has been controversial. Sirolimus-eluting stent (SES) has been shown to be better outcomes compared with bare metal stent (BMS). We prospectively investigated the early inflammatory response after SES or BMS implantation in patients with single-vessel lesion, and evaluated the relationship between inflammation and late clinical outcomes in a randomized design. METHODS Forty-eight patients with single-vessel disease were randomized into SES or BMS implantation group (n=24 respectively). Blood samples were taken before stenting, 1 h, 24 h and 8 months afterward. The plasma concentrations of C-reactive protein (CRP) and interleukin-6 (IL-6) were determined by ELISA. The clinical and angiographic follow-up were performed at 8 months after stenting. RESULTS There was no difference in baseline characteristics, plasma CRP and IL-6 concentrations between the 2 groups. However, plasma IL-6 concentrations at 1 h after stenting were higher in both groups than in baseline (p<0.01). In addition, the plasma CRP and IL-6 concentrations at 24 h after stenting were significantly higher in both groups compared with baseline (p<0.01 respectively). Likewise, plasma CRP and IL-6 concentrations were significantly higher in BMS group compared with SES group at 24 h after stenting (p<0.05 respectively). At the follow-up (mean 8 months after stenting), the rate of in-stent restenosis (ISR) and target lesion revascularization (TLR) were higher in BMS group than in SES group (p<0.05 respectively) although the plasma CRP and IL-6 concentrations are similar between the groups. CONCLUSIONS Single coronary stenting could trigger an early inflammatory response. However, patients undergoing SES implantation has less augmentation of early inflammatory markers after stenting compared to patients treated with BMS, which was positively related the incidence of ISR and TLR at follow-up. This may reflect the potential impact of SES implantation on the early inflammatory response and late clinical outcomes.
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Affiliation(s)
- Jian-Jun Li
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, PR China.
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29
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Abstract
Coronary heart disease remains the major cause of mortality and morbidity in the United States and other western countries despite major advances in its treatment. During the last decades, many markers of coronary artery disease have been found which help predict future risk of cardiovascular events. High-sensitivity C-reactive protein has been studied extensively and was seen to be associated with a higher risk of cardiovascular events in patients with acute coronary syndromes and/or peripheral artery disease. Discussed in this review is the latest literature about this marker and its association with cardiovascular disease, as well as the latest therapeutic options available.
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Kruk M, Przyluski J, Kalinczuk L, Pregowski J, Deptuch T, Kadziela J, Bekta P, Karcz M, Demkow M, Chmielak Z, Witkowski A, Ruzyllo W, on behalf of ANIN Myocardial Infarction Registry Group. Association of Non-Specific Inflammatory Activation With Early Mortality in Patients With ST-Elevation Acute Coronary Syndrome Treated With Primary Angioplasty. Circ J 2008; 72:205-11. [DOI: 10.1253/circj.72.205] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mariusz Kruk
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Jakub Przyluski
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Lukasz Kalinczuk
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Jerzy Pregowski
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Tomasz Deptuch
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Jacek Kadziela
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Pawel Bekta
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Maciej Karcz
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Marcin Demkow
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Zbigniew Chmielak
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Adam Witkowski
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
| | - Witold Ruzyllo
- Cathetherization Laboratory and Coronary Disease Unit, National Institute of Cardiology
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