Comparison of the chronic anti-inflammation effects after implantation of drug eluting stent and bare metal stent
目的: 経皮的冠動脈インターベンション(percutaneous coronary intervention; PCI)前と慢性期の血清炎症およびその関連マーカーについて薬剤溶出ステント(drug-eluting stent; DES)使用群とベアメタルステント(bare metal stent; BMS)使用群で比較検討し, さらにDES使用群については, パクリタキセル溶出性ステント(paclitaxel-eluting stent; PES)使用群とシロリムス溶出性ステント(sirolimus-eluting stent; SES)使用群で比較検討した.方法: 対象はPCIに成功したSE...
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| Published in | Shinzo Vol. 43; no. 10; pp. 1319 - 1327 |
|---|---|
| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
Japan Heart Foundation
2011
公益財団法人 日本心臓財団 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0586-4488 2186-3016 |
| DOI | 10.11281/shinzo.43.1319 |
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| Abstract | 目的: 経皮的冠動脈インターベンション(percutaneous coronary intervention; PCI)前と慢性期の血清炎症およびその関連マーカーについて薬剤溶出ステント(drug-eluting stent; DES)使用群とベアメタルステント(bare metal stent; BMS)使用群で比較検討し, さらにDES使用群については, パクリタキセル溶出性ステント(paclitaxel-eluting stent; PES)使用群とシロリムス溶出性ステント(sirolimus-eluting stent; SES)使用群で比較検討した.方法: 対象はPCIに成功したSES; 44病変, PES; 39病変, BMS; 36病変. 患者背景, PCI時のデータならびに心事故発生率を3群間で比較し, 血液生化学検査は, hs-CRP(high-sensitivity C-reactive protein), IL-6(interleukin-6), ネオプテリン, ICAM-1(inter-cellular adhesion molecule 1), VCAM-1(vascular cell adhesion molecule 1)をPCI前とPCI 6カ月前後に測定し比較検討した.結果: 患者背景は, 糖尿病罹患率がPES群で有意に高く, 病変背景は平均ステント長がSES群で有意に長かった. 定量的冠動脈造影解析(quantitative coronary arteriography; QCA)では, PCI前の最小血管内腔径がPES群で有意に小さかったことを除き, 3群間で病変長, 対照血管径, ステント本数, ステント長, PCI成功率に差はなかった. hs-CRPとIL-6の値はBMS群ではPCI前と慢性期で変化しなかったが, DES群ではPCI前に比べ, 慢性期に有意に減少した(log hs-CRP; BMS群PCI前3.05±0.57, 後2.98±0.58, p=ns, DES群PCI前3.12±0.61, 後2.81±0.50, p<0.010; IL-6, BMS群PCI前3.45±3.66, 後4.66±5.12, p=ns, DES群6.70±4.46, 後2.31±1.54, p=0.020). しかし, SES群とPES群間に差はなかった. また, ネオプテリン, ICAM-1, VCAM-1はBMS群, DES群いずれもPCI前後で変化しなかった.結論: 血清hs-CRPとIL-6の炎症マーカーがBMS群に比べDES群でのみ慢性期に有意に減少したことはPCI標的部位の炎症性変化を反映している可能性があり, 心事故や再狭窄の抑制効果の高いDESは病変局所の炎症反応抑制の役割を果たしているかもしれない. |
|---|---|
| AbstractList | 目的: 経皮的冠動脈インターベンション(percutaneous coronary intervention; PCI)前と慢性期の血清炎症およびその関連マーカーについて薬剤溶出ステント(drug-eluting stent; DES)使用群とベアメタルステント(bare metal stent; BMS)使用群で比較検討し, さらにDES使用群については, パクリタキセル溶出性ステント(paclitaxel-eluting stent; PES)使用群とシロリムス溶出性ステント(sirolimus-eluting stent; SES)使用群で比較検討した.方法: 対象はPCIに成功したSES; 44病変, PES; 39病変, BMS; 36病変. 患者背景, PCI時のデータならびに心事故発生率を3群間で比較し, 血液生化学検査は, hs-CRP(high-sensitivity C-reactive protein), IL-6(interleukin-6), ネオプテリン, ICAM-1(inter-cellular adhesion molecule 1), VCAM-1(vascular cell adhesion molecule 1)をPCI前とPCI 6カ月前後に測定し比較検討した.結果: 患者背景は, 糖尿病罹患率がPES群で有意に高く, 病変背景は平均ステント長がSES群で有意に長かった. 定量的冠動脈造影解析(quantitative coronary arteriography; QCA)では, PCI前の最小血管内腔径がPES群で有意に小さかったことを除き, 3群間で病変長, 対照血管径, ステント本数, ステント長, PCI成功率に差はなかった. hs-CRPとIL-6の値はBMS群ではPCI前と慢性期で変化しなかったが, DES群ではPCI前に比べ, 慢性期に有意に減少した(log hs-CRP; BMS群PCI前3.05±0.57, 後2.98±0.58, p=ns, DES群PCI前3.12±0.61, 後2.81±0.50, p<0.010; IL-6, BMS群PCI前3.45±3.66, 後4.66±5.12, p=ns, DES群6.70±4.46, 後2.31±1.54, p=0.020). しかし, SES群とPES群間に差はなかった. また, ネオプテリン, ICAM-1, VCAM-1はBMS群, DES群いずれもPCI前後で変化しなかった.結論: 血清hs-CRPとIL-6の炎症マーカーがBMS群に比べDES群でのみ慢性期に有意に減少したことはPCI標的部位の炎症性変化を反映している可能性があり, 心事故や再狭窄の抑制効果の高いDESは病変局所の炎症反応抑制の役割を果たしているかもしれない. |
| Author | Yabe, Akihisa Horinaka, Shigeo Yagi, Hiroshi Ishimura, Kimihiko Iemura, Tomomi Ishimitsu, Toshihiko Yano, Hideki |
| Author_FL | 堀中 繁夫 家村 知海 八木 博 石村 公彦 矢部 彰久 矢野 秀樹 石光 俊彦 |
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| References | 3) Ridker PM: C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007; 49: 2129-2138 15) Inoue T, Kato T, Uchida T, et al: Local release of C-reactive protein from vulnerable plaque or coronary arterial wall injured by stenting. J Am Coll Cardiol 2005; 46: 239-245 17) Kobayashi S, Inoue N, Ohashi Y, et al: Interaction of oxidative stress and inflammatory response in coronary plaque instability: important role of C-reactive protein. Arterioscler Thromb Vasc Biol 2003; 23: 1398-1404 9) Li JJ, Zhang YP, Wang C, et al: Impact of direct sirolimus-eluting stent implantation on the early systemic inflammatory response compared with complementary stent implantation. Coron Artery Dis 2009; 20: 65-70 7) Kim JY, Ko YG, Shim CY, et al: Comparison of effects of drug-eluting stents versus bare metal stents on plasma C-reactive protein levels. Am J Cardiol 2005; 96: 1384-1388 11) Versaci F, Gaspardone A: Prevention of restenosis after stenting: the emerging role of inflammation. Coron Artery Dis 2004; 15: 307-311 29) Li JJ, Ren Y, Chen KJ, et al: Impact of C-reactive protein on in-stent restenosis: a meta-analysis. Tex Heart Inst J 2010; 37: 49-57 23) Windecker S, Remondino A, Eberli FR, et al: Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med 2005; 353: 653-662 5) Walter DH, Fichtlscherer S, Sellwig M, et al: Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation. J Am Coll Cardiol 2001; 37: 839-846 27) Luc G, Arveiler D, Evans A, et al: Circulating soluble adhesion molecules ICAM-1 and VCAM-1 and incident coronary heart disease: the PRIME Study. Atherosclerosis 2003; 170: 169-176 19) Joner M, Finn AV, Farb A, et al: Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48: 193-202 18) Gaspardone A, Crea F, Versaci F, et al: Predictive value of C-reactive protein after successful coronary-artery stenting in patients with stable angina. Am J Cardiol 1998; 82: 515-518 28) Adachi T, Naruko T, Itoh A, et al: Neopterin is associated with plaque inflammation and destabilisation in human coronary atherosclerotic lesions. Heart 2007; 93: 1537-1541 13) Li JJ, Li J, Nan JL, et al: Coronary restenotic reduction of drug-eluting stenting may be due to its anti-inflammatory effects. Med Hypotheses 2007; 69: 1004-1009 24) Levin AD, Vukmirovic N, Hwang CW, Edelman ER: Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel. Proc Natl Acad Sci U S A 2004; 101: 9463-9467 26) Lee SW, Park SW, Kim YH, et al: A randomized comparison of sirolimus- versus Paclitaxel-eluting stent implantation in patients with diabetes mellitus. J Am Coll Cardiol 2008; 52: 727-733 14) Yazdani S, Simon AD, Vidhun R, et al: Inflammatory profile in unstable angina versus stable angina in patients undergoing percutaneous interventions. Am Heart J 1998; 136: 357-361 4) Calabró P, Willerson JT, Yeh ET: Inflammatory cytokines stimulated C-reactive protein production by human coronary artery smooth muscle cells. Circulation 2003; 108: 1930-1932 20) Suzuki T, Kopia G, Hayashi S, et al: Stent-based delivery of sirolimus reduces neointimal formation in a porcine coronary model. Circulation 2001; 104: 1188-1193 2) Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836-843 12) Cirillo P, Golino P, Calabr P, et al: C-reactive protein induces tissue factor expression and promotes smooth muscle and endothelial cell proliferation. Cardiovasc Res 2005; 68: 47-55 21) Dumont FJ, Su Q: Mechanism of action of the immunosuppressant rapamycin. Life Sci 1996; 58: 373-395 1) Koenig W, Sund M, Fröhlich M, et al: C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA(Monitoring Trends and Determinants in Cardiovascular Disease)Augsburg Cohort Study, 1984 to 1992. Circulation 1999; 99: 237-242 6) Montone RA, Ferrante G, Bacà M, Niccoli G: Predictive value of C-reactive protein after drug-eluting stent implantation. Future Cardiol 2010; 6: 167-179 8) Kang WC, Ahn TH, Moon CI, et al: Comparison of inflammatory markers and angiographic outcomes after implantation of sirolimus and paclitaxel-eluting stents. Heart 2009; 95: 970-975 22) Perin EC: Choosing a drug-eluting stent: a comparison between CYPHER and TAXUS. Rev Cardiovasc Med 2005; 6(Suppl 1): S13-S21 10) Gaspardone A, Versaci F: Coronary stenting and inflammation. Am J Cardiol 2005; 96: 65L-70L 25) Morice MC, Colombo A, Meier B, et al: Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the REALITY trial: a randomized controlled trial. JAMA 2006; 295: 895-904 16) Yasojima K, Schwab C, McGeer EG, McGeer PL: Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158: 1039-1051 |
| References_xml | – reference: 28) Adachi T, Naruko T, Itoh A, et al: Neopterin is associated with plaque inflammation and destabilisation in human coronary atherosclerotic lesions. Heart 2007; 93: 1537-1541 – reference: 22) Perin EC: Choosing a drug-eluting stent: a comparison between CYPHER and TAXUS. Rev Cardiovasc Med 2005; 6(Suppl 1): S13-S21 – reference: 6) Montone RA, Ferrante G, Bacà M, Niccoli G: Predictive value of C-reactive protein after drug-eluting stent implantation. Future Cardiol 2010; 6: 167-179 – reference: 13) Li JJ, Li J, Nan JL, et al: Coronary restenotic reduction of drug-eluting stenting may be due to its anti-inflammatory effects. Med Hypotheses 2007; 69: 1004-1009 – reference: 17) Kobayashi S, Inoue N, Ohashi Y, et al: Interaction of oxidative stress and inflammatory response in coronary plaque instability: important role of C-reactive protein. Arterioscler Thromb Vasc Biol 2003; 23: 1398-1404 – reference: 1) Koenig W, Sund M, Fröhlich M, et al: C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA(Monitoring Trends and Determinants in Cardiovascular Disease)Augsburg Cohort Study, 1984 to 1992. Circulation 1999; 99: 237-242 – reference: 8) Kang WC, Ahn TH, Moon CI, et al: Comparison of inflammatory markers and angiographic outcomes after implantation of sirolimus and paclitaxel-eluting stents. Heart 2009; 95: 970-975 – reference: 7) Kim JY, Ko YG, Shim CY, et al: Comparison of effects of drug-eluting stents versus bare metal stents on plasma C-reactive protein levels. Am J Cardiol 2005; 96: 1384-1388 – reference: 26) Lee SW, Park SW, Kim YH, et al: A randomized comparison of sirolimus- versus Paclitaxel-eluting stent implantation in patients with diabetes mellitus. J Am Coll Cardiol 2008; 52: 727-733 – reference: 18) Gaspardone A, Crea F, Versaci F, et al: Predictive value of C-reactive protein after successful coronary-artery stenting in patients with stable angina. Am J Cardiol 1998; 82: 515-518 – reference: 29) Li JJ, Ren Y, Chen KJ, et al: Impact of C-reactive protein on in-stent restenosis: a meta-analysis. Tex Heart Inst J 2010; 37: 49-57 – reference: 11) Versaci F, Gaspardone A: Prevention of restenosis after stenting: the emerging role of inflammation. Coron Artery Dis 2004; 15: 307-311 – reference: 10) Gaspardone A, Versaci F: Coronary stenting and inflammation. Am J Cardiol 2005; 96: 65L-70L – reference: 20) Suzuki T, Kopia G, Hayashi S, et al: Stent-based delivery of sirolimus reduces neointimal formation in a porcine coronary model. Circulation 2001; 104: 1188-1193 – reference: 9) Li JJ, Zhang YP, Wang C, et al: Impact of direct sirolimus-eluting stent implantation on the early systemic inflammatory response compared with complementary stent implantation. Coron Artery Dis 2009; 20: 65-70 – reference: 27) Luc G, Arveiler D, Evans A, et al: Circulating soluble adhesion molecules ICAM-1 and VCAM-1 and incident coronary heart disease: the PRIME Study. Atherosclerosis 2003; 170: 169-176 – reference: 4) Calabró P, Willerson JT, Yeh ET: Inflammatory cytokines stimulated C-reactive protein production by human coronary artery smooth muscle cells. Circulation 2003; 108: 1930-1932 – reference: 16) Yasojima K, Schwab C, McGeer EG, McGeer PL: Generation of C-reactive protein and complement components in atherosclerotic plaques. Am J Pathol 2001; 158: 1039-1051 – reference: 21) Dumont FJ, Su Q: Mechanism of action of the immunosuppressant rapamycin. Life Sci 1996; 58: 373-395 – reference: 2) Ridker PM, Hennekens CH, Buring JE, Rifai N: C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836-843 – reference: 14) Yazdani S, Simon AD, Vidhun R, et al: Inflammatory profile in unstable angina versus stable angina in patients undergoing percutaneous interventions. Am Heart J 1998; 136: 357-361 – reference: 25) Morice MC, Colombo A, Meier B, et al: Sirolimus- vs paclitaxel-eluting stents in de novo coronary artery lesions: the REALITY trial: a randomized controlled trial. JAMA 2006; 295: 895-904 – reference: 5) Walter DH, Fichtlscherer S, Sellwig M, et al: Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation. J Am Coll Cardiol 2001; 37: 839-846 – reference: 19) Joner M, Finn AV, Farb A, et al: Pathology of drug-eluting stents in humans: delayed healing and late thrombotic risk. J Am Coll Cardiol 2006; 48: 193-202 – reference: 3) Ridker PM: C-reactive protein and the prediction of cardiovascular events among those at intermediate risk: moving an inflammatory hypothesis toward consensus. J Am Coll Cardiol 2007; 49: 2129-2138 – reference: 23) Windecker S, Remondino A, Eberli FR, et al: Sirolimus-eluting and paclitaxel-eluting stents for coronary revascularization. N Engl J Med 2005; 353: 653-662 – reference: 24) Levin AD, Vukmirovic N, Hwang CW, Edelman ER: Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel. Proc Natl Acad Sci U S A 2004; 101: 9463-9467 – reference: 12) Cirillo P, Golino P, Calabr P, et al: C-reactive protein induces tissue factor expression and promotes smooth muscle and endothelial cell proliferation. Cardiovasc Res 2005; 68: 47-55 – reference: 15) Inoue T, Kato T, Uchida T, et al: Local release of C-reactive protein from vulnerable plaque or coronary arterial wall injured by stenting. J Am Coll Cardiol 2005; 46: 239-245 |
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| Snippet | 目的: 経皮的冠動脈インターベンション(percutaneous coronary intervention; PCI)前と慢性期の血清炎症およびその関連マーカーについて薬剤溶出ステント(drug-eluting... |
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| SubjectTerms | DES PCI 心事故 炎症反応抑制効果 |
| Title | Comparison of the chronic anti-inflammation effects after implantation of drug eluting stent and bare metal stent |
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