Periprocedural Kinetics in Serum Levels of Cytokines and Adhesion Molecules in Elective PTCA and Stent Implantation: Impact on Restenosis

Abstract

To the Editor: Coronary restenosis after percutaneous transluminal coronary angioplasty (PTCA) remains a significant clinical problem occurring in ≈30% of patients even after wide accessibility and application of intraluminal stent implantation. Recent developments in stent design have made new techniques such as brachytherapy and drug-eluting stents available for clinical approaches; nonetheless, restenosis with its complex multifactorial genesis will continue to be an important problem with a major impact on long-term outcome of patients after coronary interventions. Several factors have been suggested to serve as predictors of the later occurrence of restenosis, but no serum parameter with predictive value has been clinically established so far. The pathophysiology of coronary restenosis has not been fully elucidated; however, an initial vascular injury is supposed to initiate a local inflammatory response that induces the recruitment of circulating immune-competent cells through an increased expression and translocation of several adhesion molecules such as P-selectin, E-selectin, and monocyte chemoattractant molecule-1 (MCP-1).1,2⇓ Migration of leukocytes, release of cytokines, and growth factors result in the induction of local inflammatory reactions and vascular remodeling.3 Patients with angina pectoris and acute myocardial infarction show a systemic inflammatory activation and elevated serum levels of vascular adhesion molecules.1,2⇓ Therefore, the local vascular inflammation seems to be accompanied by alterations of serum parameters exhibiting a systemic inflammatory response toward local tissue damage. We investigated periprocedural serum kinetics of cytokines (TNFα and IL-1β) and adhesion molecules (ICAM-1, VCAM-1, E-selectin and P-selectin) from baseline to 48 hours after elective PTCA and intracoronary stent implantation in patients with stable angina pectoris (CCS II-III). Forty patients with stable angina pectoris and a left ventricular ejection fraction of >45% admitted for elective PTCA and stent implantation were prospectively included in this study. Before and 48 hours after intervention, venous blood samples were drawn from …