Key result
In patients undergoing saphenous vein graft stenting, diabetes mellitus was associated with higher coronary aspirate TNFα levels and greater percent diameter stenosis at 6 months (22.17% vs. 6.34%) compared to non-diabetics.
Why the study?
Does coronary aspirate TNFα correlate with saphenous vein bypass graft restenosis risk in diabetic patients undergoing stenting?
Observational (n=40)
Does coronary aspirate TNFα correlate with saphenous vein bypass graft restenosis risk in diabetic patients undergoing stenting?
In diabetic patients undergoing saphenous vein graft stenting, higher levels of TNFα in coronary aspirate correlate with an increased risk of restenosis at 6 months.
BACKGROUND: Patients with diabetes mellitus (DM) have an increased risk for periprocedural complications and adverse cardiac events after percutaneous coronary intervention. We addressed the potential for coronary microvascular obstruction and restenosis in patients with and without DM undergoing stenting for saphenous vein bypass graft (SVG) stenosis under protection with a distal occlusion/aspiration device. METHODS: SVG plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Percent diameter stenosis was determined from quantitative coronary angiography before, immediately after and 6 months after stent implantation. Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Total calcium, several vasoconstrictors, and tumor necrosis factor (TNF)α in particulate debris and coronary aspirate plasma were determined. RESULTS: Patients with and without DM had similar plaque volume, but larger necrotic core and greater particulate debris release in patients with than without DM (20.3±2.7 vs. 12.7±2.6% and 143.9±19.3 vs. 75.1±10.4 mg, P<0.05). The TNFα concentration in particulate debris and coronary aspirate plasma was higher in patients with than without DM (15.9±6.6 vs. 5.1±2.4 pmol/mg and 2.2±0.7 vs. 1.1±0.2 pmol/L, P<0.05), whereas total calcium and vasoconstrictors were not different. Patients with DM had a greater percent diameter stenosis 6 months after stent implantation than those without DM (22.17±5.22 vs. 6.34±1.11%, P<0.05). The increase in TNFα immediately after stent implantation correlated with restenosis 6 months later (r=0.69, P<0.05). CONCLUSION: In diabetics, particulate debris and coronary aspirate plasma contained more TNFα, which might reflect the activity of the underlying atherosclerotic process. TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov/ct2/results?term=NCT01430884; unique identifier: NCT01430884.
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Baars et al. (2013) conducted an observational in Saphenous vein bypass graft stenosis (n=40). Diabetes mellitus vs. Without diabetes mellitus was evaluated on Percent diameter stenosis 6 months after stent implantation (p=<0.05). In patients undergoing saphenous vein graft stenting, diabetes mellitus was associated with higher coronary aspirate TNFα levels and greater percent diameter stenosis at 6 months (22.17% vs. 6.34%) compared to non-diabetics.
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