Circulating intermediate monocytes increase after elective percutaneous coronary intervention

Abstract

Abstract Introduction Inflammation plays a central role in the pathogenesis of atherosclerosis and in the sequelae of percutaneous coronary intervention (PCI). Previous work demonstrated that intermediate monocytes (CD14++CD16+) are associated with adverse cardiovascular events, yet monocyte subset response following elective PCI has not been described. This study explores the changes in monocyte subset and humoral response after elective PCI. Methods In this prospective study we recruited patients undergoing elective PCI for stable angina due to de novo coronary artery disease, either with DES or DCB utilised at the discretion of the operator. We excluded patients with significant renal impairment or any significant inflammatory condition on immunosuppression. All patients provided written, informed consent. Patients had blood tests at baseline (prior to PCI), four hours, two weeks and two months later. Analyses were performed in terms of monocyte subsets (classical CD14++CD16-, intermediate CD14+CD16+ and non-classical CD14+CD16++), gene expression of CD14+ leucocytes and humoral biomarkers. Results Some 30 patients were recruited in the study; two patients were lost to follow-up and two patients were excluded as they had raised baseline (pre-PCI) troponin; therefore 26 patients were included in analysis. Intermediate monocytes decreased significantly four hours after PCI, were recovered at two weeks, and increased significantly at two months post elective, uncomplicated PCI (Fig 1). The classical monocytes appeared to follow the opposite pattern to intermediate monocytes while the non-classical monocytes did not change significantly, suggesting that there was a shift from classical to intermediate monocytes and vice versa. Subgroup analysis showed that the intermediate monocytes remained significantly elevated in the DES group but not in the DCB group (Fig 2). Gene expression analysis of CD14+ leucocytes showed that IL18 had decreased expression at two weeks, CXCR4 and IL1β decreased at two months, while pentraxin 3 increased at two weeks and two months. In terms of humoral biomarkers, hsTnI remained elevated up to two weeks post PCI while IL6 and TNFα remained elevated till two months post PCI. Conclusion Intermediate monocytes, a highly proatherogenic monocyte subset, increase significantly two months following elective, uncomplicated PCI. They remain significantly elevated in the DES group but not in the DCB group suggesting that the PCI strategy could be one of the ways to modulate the inflammatory response post PCI and improve patient outcomes.Monocyte response after PCIMonocyte response after DCB(A) or DES(B)