Depressed Inflammatory Response to Repeated Angioplasty in Unstable Angina Patients with an In-Stent Restenosis

2004 ◽  
Vol 34 (1) ◽  
pp. 41
Author(s):  
Sang Jin Han ◽  
Young Cheoul Doo ◽  
Goo Yung Cho ◽  
Kyung Soon Hong ◽  
Kyoo Rok Han ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Unstable Angina ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract 5609: In-Stent Restenosis - Benign or Dangerous? Clinical Presentation of Coronary Restenosis in Sweden

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Elmir Omerovic ◽  
Truls Ramunddal ◽  
Lars Grip ◽  
Jan Boren ◽  
Goran Matejka ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Unstable Angina ◽  
Balloon Angioplasty ◽  
Stable Angina ◽  
Metal Stents ◽  
List Type ◽  
Coronary Restenosis ◽  
Coronary Syndrome ◽  
Stent Restenosis ◽  
In Stent Restenosis

Background Restenosis after percutaneous coronary intervention (PCI) was earlier thought to be a benign event clinically manifested as stable exertional angina. The aim of this prospective multicenter registry study was to investigate the incidence of acute coronary syndrome in patients with restenosis in Sweden. Methods Using data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we analyzed all registered cases of PCI for restenosis (in-stent, after balloon angioplasty) from 1995 to 2005 in Sweden. Both multivessel and single vessel interventions were included. Restenosis presentations were classified as: stable angina; unstable angina/non-STEMI; STEMI; and other reasons. As routine angiographic screening was not performed, restenosis episodes were defined clinically based on symptoms. Results We identified 6642 cases of restenosis in 2978 patients (4790 in men, 1852 in women). Restenosis presented in 39.7% of cases as stable angina, in 46.0% as unstable angina/non-STEMI, in 11.5% as STEMI and in 2.8% as other reasons. Cardiogenic shock was reported in 48 patients. Women had a higher incidence of unstable angina/non-STEMI compared with men (52.3% v. 43.6%) but a lower incidence of STEMI (9.6% v. 12.2%). The frequency of STEMI was lower with restenosis after balloon angioplasty v. in-stent restenosis (6.9% v. 13.8%), and after drug-eluting stents v. bare metal stents (7.9% v. 18.5%). Mortality rate was 1.7% at 30 days, 3.2% at 6 months and 4.6% at one year in patients with restenosis. These covariates were independent predictors of acute coronary syndrome: gender, age, vessel diameter, smoking, stent type, number of stents, treated vessel, previous stroke and previous infarction. Conclusion The majority of patients with coronary restenosis present either with acute MI or unstable angina requiring hospitalization and new interventions. Women may have a higher risk of developing acute coronary syndrome due to restenosis. Prevention of restenosis may be an important target for improvement of “hard” clinical outcomes in patients undergoing coronary revascularization.

Abstract 3037: Immuno-inflammatory Cascade Activation and Restenosis in Stable and Unstable Angina Patients Undergoing Coronary Interventions

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Georgia Karabela ◽  
Stamatis Adamopoulos ◽  
George Karavolias ◽  
Antigoni Haidaroglou ◽  
Dimitrios Degiannis ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Adhesion Molecule ◽  
Inflammatory Marker ◽  
Control Group ◽  
List Type ◽  
Inflammatory Cascade ◽  
Stent Restenosis ◽  
Plaque Disruption ◽  
Anti Inflammatory ◽  
In Stent Restenosis

Background: Inflammation is an important feature of atherosclerotic lesions and associated with the development of restenosis after coronary angioplasty. The purpose of this study was to investigate whether “active” coronary plaque disruption during percutaneous coronary intervention (PCI), further provokes the activation of immuno-inflammatory cascade and predisposes to restenosis, in stable and unstable angina patients. Methods and Results: We assessed the levels of soluble intercellular adhesion molecule (s-ICAM-1), vascular adhesion molecule (s-VCAM-1), metalloproteinase (MMP-9), metalloproteinase inhibitor (TIMP-2), monocyte chemoattractant proteine-1 (MCP-1), T cells chemoattractant proteine IP-10, interleukine-6 (IL-6), C-reactive proteine (CRP) and anti-inflammatory marker IL-10, in 43 stable angina (SA) and 46 unstable angina (UA) patients, before, 12 h and 40 h after PCI. As a control group, we studied 19 SA and 20 UA patients, after coronary angiography. After PCI, serum levels of VCAM-1, MMP-9, IL-6 and CRP increased significantly in both groups, in SA ( p < 0.01) and UA ( p < 0.001) , while levels of ICAM-1, MCP-1, IP-10, TIMP and IL-10, did not change significantly. After diagnostic angiography, a significant elevation in CRP was observed in SA patients ( p =0.04), while no difference in any inflammatory marker was detected in UA patients. At 6 months follow-up, 27 out of 89 pts underwent re-angiography because of: positive stress test in 25 pts and UA in 2 pts. Restenosis (lumen diameter stenosis ≥50%) was observed in 12 pts (14%). A positive correlation (p=0.04) was found between IL-10 levels at 12h post-PCI and in stent restenosis (Relative risk [RR]=1.14, 95% CI 1.006 –1.2933). We found no correlation between in-stent restenosis and all the other inflammatory markers. Conclusion: Our results provide further evidence of the role of iatrogenic plaque disruption inducing immunoinflammatory responses detectable in systemic circulation, especially in UA patients. The elevation of anti-inflammatory cytokine IL-10 after PCI is associated with in-stent restenosis. This anti-inflammatory marker, strong indicator of an activated inflammatory process, could probably be used as independent predictor of in-stent restenosis.

scholarly journals Predictive Value of C-reactive Protein in Patients with Unstable Angina Pectoris Undergoing Coronary Artery Stent Implantation

2005 ◽  
Vol 33 (4) ◽  
pp. 389-396 ◽  
Author(s):  
I Karaca ◽  
K Aydin ◽  
M Yavuzkir ◽  
E Ilkay ◽  
M Akbulut ◽  
...  
Keyword(s):  
Angina Pectoris ◽  
Unstable Angina ◽  
Stent Implantation ◽  
Unstable Angina Pectoris ◽  
C Reactive Protein ◽  
Predictive Values ◽  
Reactive Protein ◽  
Stent Restenosis ◽  
Coronary Stent Implantation ◽  
In Stent Restenosis

In-stent restenosis is a major problem following coronary stent implantation, and inflammation plays an active role. We evaluated the effectiveness of the inflammatory marker C-reactive protein (CRP) as a predictor of in-stent restenosis after successful stent implantation, in 86 patients with unstable angina pectoris. Plasma CRP was measured in all patients before the procedure, and at 48-72 h and 1, 2 and 3 months post-procedure. An angiographic loss of 50% at follow-up was accepted as in-stent restenosis. We found negative and positive predictive values of the pre-procedural plasma CRP for determining 6-month in-stent restenosis of 34% and 61%, respectively. We also found a strong correlation between the 3-month post-procedural CRP value and 6-month in-stent restenosis; the negative and positive predictive values being 8% and 76%, respectively. In conclusion, we showed that a plasma CRP value > 3 mg/l in the third month after coronary stent implantation was a strong predictor of angiographic in-stent restenosis.

Is IL-10 a predictor of in-stent restenosis in stable and unstable angina patients undergoing coronary interventions?

2014 ◽  
Vol 176 (3) ◽  
pp. 1156-1157 ◽  
Author(s):  
Georgia Karabela ◽  
George Karavolias ◽  
Antigoni Chaidaroglou ◽  
Christos Theleritis ◽  
Dimitrios Degiannis ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Coronary Interventions ◽  
Stent Restenosis ◽  
In Stent Restenosis

P1699Non-ST segment elevation miocardial infarction (NSTEMI) vs. Unstable angina (UA) in young women aged < 45 years - differences in symptomatology, clinical course, treatment and prognosis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Beckowski ◽  
M Gierlotka ◽  
L Polonski ◽  
M Gasior ◽  
R Dabrowski ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Unstable Angina ◽  
Young Women ◽  
Clinical Course ◽  
Killip Class ◽  
Diagonal Branch ◽  
St Segment Elevation ◽  
Atypical Symptoms ◽  
Stent Restenosis ◽  
In Stent Restenosis

Abstract Background Almost 50% of all ACS in young women are NSTEMI and UA. Due to the type of ACS we observed differences in the symptomatology, treatment and outcomes. The aim was to evaluate the differences in the clinical course and prognosis in young women aged ≤45 years with NSTEMI vs. UA. Methods We compared 1143 women aged ≤45y.o. with acute cardiac syndromes: 51% NSTEMI, 49% UA from the PL-ACS registry between 2007 - 2014. Results Chest pain was predominant in both group, with a higher incidence in NSTEMI group (91.7% vs. 84.7, p=0.0002). UA group was older (42y.o. vs. 41y.o p=0.003), more often presents atypical symptoms (8.0% vs. 1.5%, p<0,0001) mostly with dyspnea (3.9%vs. 1.7%, p=0.025). During NSTEMI more often occurred pre-hospital cardiac arrest (2.9% vs. 0.8%, p=0.0031). There was no difference between groups in general condition at admission expressed by Killip class. Onset-to-intervention time was longer in UA group (41.8 vs. 30.3 hour p=0.0053) resulted from longer door-to-intervention time only (3.3 vs. 1.5 hour, p<0.0001). In NSTEMI group more often the culprit artery was circumflex (17.1% vs. 9.3% p=0.0004) and diagonal branch (4.4% vs. 1.5%, p=0.0095) with a higher number of total occlusions (pre-procedural TIMI 0: 27.8% vs. 15.6% p=0,0023). Number of PCI was also higher in this group (50.9% vs. 36.1%, p<0.0001) without differences in completed revascularizations. In UA group in stent restenosis was found more often (2.8% vs. 1.5%, p=0.026). Drug eluting stents (DES) were often used in UA group (60.2% vs. 49.6% p=0.027). There were no difference in the incidence of PCI complications. We observed a lower usage of clopidogrel, GP IIb/IIIa inhibitors and parenteral anticoagulant in UA group during hospitalization (for all p<0.0001). Ejection fraction LVEF was higher in UA group (56% vs. 54% p=0.0026) at discharge. The 30-day and 1 year prognosis in both group was low with no statistical difference (Table 1). Table 1. Mortality rate in studied group NSTEMI group (N=580) UA group (N=563) P 30-day mortality 1.60% 0.70% 0.1799 6-month mortality 2.20% 0.90% 0.0662 One year mortality 3.10% 1.60% 0.0940 Conclusions Clinical course of ACS in young women is different regardless of the type of ACS (NSTEMI/UA) however with no difference in mortality rate. Typical symptoms increases the probability of unstable angina (UA) 2.8 times (p=0.0003). In the UA group, ACS was rarely related to circumflex and diagonal branch with more frequent in-stent restenosis. PCI delay in patients with UA results from a longer door-to-ballon time.

Late-phase inflammatory response as a feature of in-stent restenosis after drug-eluting stent implantation

2013 ◽  
Vol 24 (5) ◽  
pp. 368-373 ◽  
Author(s):  
Shuichi Yoneda ◽  
Shichiro Abe ◽  
Tomoaki Kanaya ◽  
Kazuhiko Oda ◽  
Setsu Nishino ◽  
...  
Keyword(s):  
Inflammatory Response ◽  
Stent Implantation ◽  
Late Phase ◽  
Drug Eluting Stent ◽  
Stent Restenosis ◽  
Drug Eluting ◽  
In Stent Restenosis
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