Wpływ wielkości urazu naczynia związanego z implantacją stentu na odpowiedź zapalną The impact of the magnitude of stenting-related vessel injury on the inflammatory response

Background: The magnitude of inflammatory response triggered in patients undergoing coronary stenting is believed to be a reliable predictor of the long-term outcome. We aimed to determine whether procedure-related variables such as stent dimensions, area of vessel injury and maximal implantation pressure have any impact on the magnitude of inflammatory response in these subjects. Material and methods: 198 stable angina patients treated with single vessel stainless steel coronary stenting were enrolled into the prospective cohort study. C-reactive protein (CRP), serum amyloid A (SAA) were measured in blood samples collected before and 6, 24 hours and 1 month after the intervention. Clinical follow-up visits were performed 7 days*, 1*, 3, 6*, 12 months (*with exercise test) after stenting. Any symptoms of restenosis were verified angiographically. Results: At 1 year follow-up clinical restenosis occurred in 30 patients. A comparable pattern of inflammatory response in terms of CRP and SAA with the peak values at 24 hours was observed in subjects who developed clinical restenosis as well as in subjects who did not. However, the magnitude of the inflammatory response and correlation coefficient with preprocedural level were significantly higher in the restenosis group. Moreover, an analysis with the application of the logistic regression model revealed increased baseline SAA concentrations and elevated levels of both CRP and SAA at 24 hours as reliable predictors of clinical restenosis. Stent dimensions, area of vessel injury and maximal implantation pressure but baseline concen- trations of acute phase reactants did not correlate with the highest markers' values. Conclusions: The magnitude of systemic inflammatory response induced by coronary stenting remains independent from stent dimensions, area of vessel injury and maximal implantation pressure but is closely correlated with the preprocedural levels of inflammatory reactants, in