Stent Restenozunu Tahmin Etmede Sistemik İmmün İnflamasyon İndeksinin Rolü

Abstract

Amaç: Koroner arter hastalığı için implante edilen stentlerin restenozu önemli bir sorun olarak karşımıza çıkmaktadır ve hangi hastalarda gelişebileceği net değildir. Aterosklerotik süreçte ve stent içi restenozda inflamasyon önemli bir rol oynamaktadır. Çalışmamızda stent içi restenozu tahmin etmede Sistemik immün inflamasyon indeksinin (SII) kullanılabilirliğinin araştırılması amaçlanmıştır. Gereç ve Yöntemler: Çalışmada Haziran 2019 ile Haziran 2022 yılları arasında akut koroner sendrom veya stabil anjina pektoris ile hastaneye başvurup başarılı stent implantasyonu uygulanmış ve sonrasında 1 yıl içinde stabil anjina pektoris nedeniyle tekrar koroner anjiografi yapılmış hastalar retrospektif olarak incelenmiştir. Hastaların ikinci yapılan koroner anjiografileri öncesinde alınan rutin hemogram testinden SII değeri (Platelet x Nötrofil) / (Lenfosit) formülü ile hesaplanmıştır. Toplam 213 hasta çalışmaya dahil edilmiştir ve hastalar stent içi restenoz olan (n:58) ve restenoz olmayan (n:155) olarak iki gruba ayrılmıştır. Bulgular: SII ortanca değeri restenoz (+) olan grupta daha yüksek saptandı (920 vs 582, p=0,001). SII değeri ile restenoz arasındaki ilişki ROC eğrisi ile değerlendirildi ve 809 optimal kesme değerinin %60,3 sensitivite ve %64,5 spesifisite ile restenozu tahmin ettiği belirlendi (Eğri altındaki alan: 0,642; %95 GA: 0,559-0,725, p=0,001). Çok değişkenli lojistik regresyon analizinde Diabetes mellitus (OR:2,409, CI %95: 1,228-4,727, p=0,011), hiperlipidemi (OR:2,703, CI %95: 1,335-5,472, p=0,006) ve Log10 SII’nin (OR:3,659, CI %95: 1,360-9,848, p=0,010) stent içi restenozun bağımsız öngördürücüsü olduğu saptandı. Sonuç: Stent içi restenozda diabet, hiperlipidemi ve inflamasyon önemli rol oynamaktadır. Bir inflamasyon belirteci olan ve kolay hesaplanabilen SII’nin stent içi restenozunun bağımsız öngördürücüsü olduğu görülmüştür. Stent içi restenozu tahmin etmede inflamasyon belirteçlerinin katkısı olabileceği düşünülmelidir.

Keywords

• Sistemik immün inflamasyon indeks
• Stent içi restenoz
• İnflamasyon
• Ateroskleroz

Role of Systemic Immune Inflammation Index in Predicting In-stent Restenosis

Abstract

Aim: Restenosis of implanted stents for coronary artery disease is an important problem and it is not clear in which patients it may develop. Inflammation plays an important role in the atherosclerotic process and in-stent restenosis. In our study, we aimed to investigate the usability of the Systemic immune inflammation index (SII) in predicting in-stent restenosis. Material and Methods: In the study, patients who were admitted to the hospital with acute coronary syndrome or stable angina pectoris and underwent successful stent implantation between June 2019 and June 2022 and then underwent coronary angiography again within 1 year due to stable angina pectoris were retrospectively analyzed. The SII value was calculated by the formula (Platelet x Neutrophil) / (Lymphocyte) from the routine hemogram test taken before the second coronary angiography of the patients. A total of 213 patients were included in the study, and the patients were divided into two groups as those with in-stent restenosis (n:58) and those without restenosis (n:155). Results: The median level of SII was found to be higher in the group with restenosis (+) (920 vs 582, p=0.001). The relationship between the SII value and restenosis was evaluated with the ROC curve, and the optimal cut-off value of 809 was determined to predict restenosis with 60.3% sensitivity and 64.5% specificity (Area under the curve: 0.642; 95% CI: 0.559-0.725, p=0.001). In multivariate logistic regression analysis, Diabetes mellitus (OR:2.409, CI 95%: 1.228-4.727, p=0.011), hyperlipidemia (OR:2.703, CI 95%: 1.335-5.472, p=0.006) and Log10 SII (OR:3,659, CI 95%: 1.360-9.848, p=0.010) was found to be an independent predictor of in-stent restenosis. Conclusion: Diabetes, hyperlipidemia and inflammation play an important role in in-stent restenosis. SII, which is an inflammation marker and can be calculated easily, was found to be an independent predictor of in-stent restenosis. It should be considered that inflammation markers may contribute to the prediction of in-stent restenosis.

Keywords

• Systemic immune inflammation index
• In-Stent restenosis
• Inflammation
• Atherosclerosis

References

1. 1. Zhang DM, Chen SL. Potential Mechanisms of In-stent Neointimal Atherosclerotic Plaque Formation. J Cardiovasc Pharmacol. 2021;78:388–93.
2. 2. Pleva L, Kukla P, Hlinomaz O. Treatment of coronary in-stent restenosis: a systematic review. J Geriatr Cardiol. 2018;15:173.
3. 3. Sabbah M, Kadota K, El-Eraky A, Kamal HM, Abdellah AT, el Hawary A. Comparison of in-stent neoatherosclerosis and tissue characteristics between early and late in-stent restenosis in second-generation drug-eluting stents: an optical coherence tomography study. Int J Cardiovasc Imaging. 2017;33:1463–72.
4. 4. Jakubiak GK, Pawlas N, Cieślar G, Stanek A. Pathogenesis and Clinical Significance of In-Stent Restenosis in Patients with Diabetes. Int J Environ Res Public Health.;18. November 1, 2021. DOI: 10.3390/IJERPH182211970.
5. 5. Drachman DE, Simon DI. Inflammation as a mechanism and therapeutic target for in-stent restenosis. Curr Atheroscler Rep. 2005;7:44–9.
6. 6. Zhu Y, Xian X, Wang Z, ve ark. Research Progress on the Relationship between Atherosclerosis and Inflammation. Biomolecules.;8. September 1, 2018. DOI: 10.3390/BIOM8030080.
7. 7. Adali MK, Buber I, Kilic O, Turkoz A, Yilmaz S. Ticagrelor improves systemic immune-inflammation index in acute coronary syndrome patients. Acta Cardiol. 2021. DOI: 10.1080/00015385.2021.1973770.
8. 8. Karimi A, Shobeiri P, Kulasinghe A, Rezaei N. Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis. Front Immunol.;12. October 22, 2021. DOI: 10.3389/FIMMU.2021.741061.

9. 9. Chen JH, Zhai ET, Yuan YJ, ve ark. Systemic immune-inflammation index for predicting prognosis of colorectal cancer. World J Gastroenterol. 2017;23:6261–72.
10. 10. Candemir M, Kiziltunç E, Nurkoç S, Şahinarslan A. Relationship Between Systemic Immune-Inflammation Index (SII) and the Severity of Stable Coronary Artery Disease. Angiology. 2021;72:575–81.
11. 11. Yang YL, Wu CH, Hsu PF ve ark. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest.;50. May 1, 2020. DOI: 10.1111/ECI.13230.
12. 12. Zhu Y, Xian X, Wang Z, ve ark. Research Progress on the Relationship between Atherosclerosis and Inflammation. Biomolecules.;8. September 1, 2018. DOI: 10.3390/BIOM8030080.
13. 13. Balta S, Celik T, Mikhailidis DP, ve ark. The Relation Between Atherosclerosis and the Neutrophil-Lymphocyte Ratio. Clin Appl Thromb Hemost. 2016;22:405–11.
14. 14. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets. 2015;26:680–1.
15. 15. An Z, Li J, Yu J, ve ark. Neutrophil extracellular traps induced by IL-8 aggravate atherosclerosis via activation NF-κB signaling in macrophages. Cell Cycle. 2019;18:2928.
16. 16. Custodio-Chablé SJ, Lezama RA, Reyes-Maldonado E. Platelet activation as a trigger factor for inflammation and atherosclerosis. Cir Cir. 2020;88:233–43.
17. 17. Sukhija R, Aronow WS, Sureddi R, ve ark. Predictors of in-stent restenosis and patient outcome after percutaneous coronary intervention in patients with diabetes mellitus. Am J Cardiol. 2007;100:777–80.
18. 18. Herder C, Dalmas E, Böni-Schnetzler M, Donath MY. The IL-1 Pathway in Type 2 Diabetes and Cardiovascular Complications. Trends Endocrinol Metab. 2015;26:551–63.
19. 19. Wolf D, Ley K. Immunity and Inflammation in Atherosclerosis. Circ Res. 2019;124:315–27.
20. 20. Guijarro C, Cosín-Sales J. LDL cholesterol and atherosclerosis: The evidence. Clin Investig Arterioscler. 2021;33 Suppl 1:25–32.
21. 21. Yoshimura M, Umemoto S, Kawano R, ve ark. Non-Fasting Hypertriglyceridemia as an Independent Risk Factor for Coronary In-Stent Restenosis after Primary Bare Metal Stent Implantation in Patients with Coronary Artery Disease. Int Heart J. 2021;62:970–9.
22. 22. Barter P. HDL-C: role as a risk modifier. Atheroscler Suppl. 2011;12:267–70.
23. 23. Ullrich H, Olschewski M, Münzel T, Gori T. Coronary In-Stent Restenosis: Predictors and Treatment. Dtsch Arztebl Int. 2021;118:637–44.
24. 24. Kastrati A, Elezi S, Dirschinger J, Hadamitzky M, Neumann FJ, Schömig A. Influence of lesion length on restenosis after coronary stent placement. Am J Cardiol. 1999;83:1617–22.