What is the clinical evidence from this study?

Study design: Cohort. Population: Stable angina (n=40). Intervention: Percutaneous transluminal coronary angioplasty with stenting vs. Baseline (pre-intervention). Primary outcome: High-sensitivity C-reactive protein (hs-CRP) level (mg/L) (p=0.001).

October 15, 2012Open Access

Prospective analysis of lipid profile parameters, inflammatory response and endothelial function markers before and after percutaneus coronary intervention in patients with stable angina

ТПТ. И. ПетелинаTomsk National Research Medical Center NMN. MusikhinaTomsk National Research Medical Center LGL. GaponRussian Academy of Sciences

Key Result

Percutaneous transluminal coronary angioplasty with stenting in patients with stable angina significantly increased high-sensitivity C-reactive protein levels from 5.10 to 14.70 mg/L at 12 months.

Study Design

Type

Cohort (n=40)

Multicenter

Structured PICO

Does PTCA with stenting alter lipid profiles, inflammatory markers, and endothelial function at 12 months in patients with stable angina and significant coronary stenosis?

Population

40 patients (mean age 57.3 years) with stable angina, including 26 with hemodynamically significant coronary stenosis who underwent percutaneous coronary intervention, followed for 12 months.

Intervention

Percutaneous transluminal coronary angioplasty (PTCA) with drug-coated stenting, followed by dual antiplatelet therapy (aspirin 75 mg/day + clopidogrel 75 mg/day) for 12 months.

Comparator

Baseline values before PTCA (prospective before-and-after analysis of the stented group).

Outcome

Changes in blood lipid profile, inflammatory markers (hs-CRP, TNF-alpha, IL-8), and endothelial dysfunction markers (endothelin-1) at 12 months post-PTCA.surrogate

While PTCA with stenting improves the lipid profile in stable angina patients, it induces a prolonged inflammatory response and persistent endothelial dysfunction at 12 months, suggesting a continued risk for late stent thrombosis.

Main Result

Absolute Event Rate: 14.7% vs 5.1%

p-value: p=0.001

Limitations

Small sample size
Single-center study

Abstract

Aim. To conduct the prospective study assessing the biochemical laboratory parameters in patients with stable angina and hemodynamically significant coronary artery stenosis before and 12 months after transluminal balloon-catheter angioplasty. Methods. 40 patients (males and females), mean age 57,3±9,6 years with stable angina and chronic coronary artery disease were examined. Patients were divided into 2 groups based on the absence (1st group, 14 patients) or presence (2st group, 26 patients) of hemodynamically significant coronary artery stenosis on selective coronary angiography. Patients with hemodynamically significant coronary artery stenosis underwent percutaneous transluminal coronary angioplasty (PTCA) with stenting (drug-coated stents). Blood lipid profile, inflammatory markers and endothelial dysfunction markers were measured before the surgery and 12 months after treatment. Results. In patients with hemodynamically significant coronary artery stenosis statistically significant association of hemodynamically significant coronary artery stenosis presence with atherogenic lipid fractions levels, inflammatory markers (high-sensitivity C-reactive protein, tumor necrosis factor-alpha) and an endothelial function parameter (endothelin-1) were revealed. Long-term results of PTCA with stenting included the significant decrease of atherogenic and increase of anti-atherogenic fractions in lipid profile. There also was a prolonged inflammatory response characterized by high-sensitivity C-reactive protein (hs-CRP) level elevation, and the endothelin system dysfunction retaining. Conclusion. Persistent hs-CRP level increase as well as endothelin-1 level increase suggest a high risk of late stent thrombosis, it should be taken into account while following-up patients at the late stages after PTCA.

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