Comparison of the Effects of Bare Metal Stents and Drug Eluting Stents on C-Reactive Protein Levels

Year 2020, Volume: 73 Issue: 3, 208 - 215, 31.12.2020

Nil Özyüncü , Hasan Sadi Güleç Özgür Ulaş Özcan , Hüseyin Göksülük , Demet Menekşe Gerede Uludağ , Çetin Erol

Abstract

Objectives: It is suggested that drug eluting stents (DES) may have systemic anti-inflammatory properties and this can play a role in decreased restenosis rates. We aimed to compare bare metal stents (BMS) and DES for their effects on C-reactive protein (CRP) levels, a good marker of systemic inflammation. We also aimed to investigate the relationship between the inflammation levels and myonecrosis and adverse cardiac events.

Materials and Methods: Patients undergoing elective stent implantation were grouped as BMS (n=70) and DES (n=42). Basal and 24th hour postprocedural CRP and creatine kinase-MB (CK-MB) levels were measured and the difference (delta=Δ) was compared between the groups. The patients were followed up for adverse cardiac events for one year.

Results: The mean age was 62±11 years and 75% were males. There was significant CRP rise in both groups at the 24th hour, but the ΔCRP was 2.1 (0.5-6.2) mg/L in the BMS group and 2.3 (0.2-5.2) mg/L in the DES group, the difference was not statistically significant (p=0.703). ΔCK-MB and adverse cardiac event rates were similar between the two groups (p=0.897 and p=0.785). There was no correlation between ΔCRP and ΔCK-MB (r=-0.090 and p=0.459 for BMS, r=0.158 and p=0.318 for DES). The effect of ΔCRP on the incidence of adverse cardiac events was not significant (p=0.349 for BMS, p=0.135 for DES).

Conclusion: Our findings reveal that patients with BMS and DES implantation exhibit similar grade of systemic inflammation after the procedure. At similar levels of systemic inflammation, the local anti-inflammatory properties of DES can play a role at decreased restenosis rates.

Key Words: Bare Metal Stent, Drug Eluting Stent, CRP, Inflammation

Keywords

Bare Metal Stent , Drug Eluting Stent , CRP , Inflammation

Ethical Statement

Etik Kurul Onayı: Ankara Üniversitesi Tıp Fakültesi (karar no: 106-2761, tarih: 22.01.2007). Hasta Onayı: Alınmıştır Hakem Değerlendirmesi: Editörler kurulunun içinden ve dışından olan kişiler tarafından değerlendirilmiştir. Yazarlık Katkıları Cerrahi ve Medikal Uygulama: N.Ö., Ö.U.Ö., H.G., Konsept: N.Ö., H.S.G., H.G., Ç.E., Dizayn: N.Ö., H.S.G., Ö.U.Ö., Veri Toplama veya İşleme: N.Ö., Ö.U.Ö., H.G., D.M.G.U., Analiz veya Yorumlama: H.S.G., Ç.E., D.M.G.U., N.Ö., Literatür Arama: N.Ö., Ö.U.Ö., H.G., D.M.G.U., Yazan: N.Ö., H.S.G. Çıkar Çatışması: Yazarlar tarafından çıkar çatışması bildirilmemiştir. Finansal Destek: Bu çalışma Klinik Vasküler Biyoloji Derneği tarafından desteklenmiştir.

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Çıplak Metal Stentler ve İlaç Salınımlı Stentlerin C-Reaktif Protein Düzeyleri Üzerine Etkilerinin Karşılaştırılması

Abstract

Amaç: İlaç salınımlı stentlerin (İSS) sistemik anti-enflamatuvar özelliklerinin olabileceği ve bunun restenoz oranlarındaki düşüşte rol oynayabileceği iddia edilmektedir. Amacımız, çıplak metal stentler (ÇMS) ile ilaç salınımlı stentleri sistemik enflamasyonun iyi bir göstergesi olan C-reaktif protein (CRP) düzeyleri üzerine etkileri açısından karşılaştırmaktı. Ayrıca enflamasyon düzeyi ile miyonekroz ve istenmeyen kardiyak olaylar arasındaki ilişkinin araştırılması da amaçlandı.

Gereç ve Yöntem: Elektif koroner stent uygulanan hastalar stent tipine göre ÇMS (n=70) ve İSS gruplarına (n=42) ayrıldı. Bazal ve işlem sonrası 24. saatteki CRP ve CK-MB düzeyleri ölçülerek aradaki fark (delta=Δ) gruplar arasında kıyaslandı. Hastalar bir yıl boyunca istenmeyen kardiyak olaylar (ölümcül olmayan miyokart enfarktüsü, ölüm ve hedef damar revaskülarizasyonu) açısından takip edildi.

Bulgular: Hastaların yaş ortalaması 62±11 olup %75’i erkek idi. Her iki stent grubunda da 24. saatte anlamlı düzeyde CRP artışı olmasına rağmen ΔCRP, ÇMS grubunda 2,1 (0,5-6,2) mg/L, İSS grubunda ise 2,3 (0,2-5,2) mg/L olup iki grup arasında anlamlı fark saptanmadı (p=0,703). Her iki stent grubunda ΔCK-MB ve majör kardiyak olay sıklığı benzerdi (p=0,897 ve p=0,785). ΔCRP ile ΔCK-MB arasında her iki stent grubunda da anlamlı korelasyon bulunmadı (ÇMS için r=-0,090 ve p=0,459, İSS için r=0,158 ve p=0,318). Benzer şekilde ΔCRP’nin istenmeyen kardiyak olay sıklığı üzerine etkisi de anlamlı değildi (ÇMS için p=0,349 ve İSS için p=0,135).

Sonuç: Bulgularımız ÇMS ve İSS uygulanan hastalarda işlem sonrası benzer düzeyde sistemik enflamatuvar yanıt oluştuğunu göstermektedir. Benzer sistemik enflamasyon düzeyleri altında İSS ile sağlanan restenoz oranlarındaki düşüşte, bu stentlerin lokal anti-enflamatuvar özellikleri rol oynuyor olabilir.

Anahtar Kelimeler: Çıplak Metal Stent, İlaç Salınımlı Stent, CRP, Enflamasyon,

Keywords

Çıplak Metal Stent , İlaç Salınımlı Stent , CRP , Enflamasyon

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