Research on the new diagnostic marker of restenosis after coronary stent implantation in elderly patients with old myocardial infarction

Abstract

Objective To study the value of circulating endothelial progenitor cell(EPC), stromal cell-derived factor-1α(SDF-1α), vascular endothelial growth factor(VEGF) and nitric oxide(NO) in diagnosis and prediction of in-stent restenosis after primary coronary intervention in elderly patients with old myocardial infarction. Methods Fifty-one elderly patients with restenosis after coronary sent implantation in Huai′an Hospital Affiliated of Xuzhou Medical University after primary coronary intervention from Jan.2007 to Sep.2016 were selected as observation group, 30 cases with the roughness of coronary vessels and without restenosis based on the analysis of coronary arteriography were considered as the control group. The patients in observation group were divided into different groups according to restenosis of vessels, severity of vessel restenosis, left ventricular ejection fraction (LVEF) and New York Heart Association (NYHA) . The levels of EPC, SDF-1α, VEGFand NO were measured in the patients. The data were compared by one-way ANOVA and LSD test. Results (1) The 1evels of EPC, SDF-1α, VEGF and NO were decreased along with the increase in the number of restenosis of vessels in elderly patients with old myocardial infarction, the differences were statistically significant(F=140.0, 122.8, 183.8, 515.8; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with multivessel restenosis were lower than that in control group, a single vessel restenosis group and double vessel restenosis group, the differences were statistically significant(with P values below 0.05). (2)Along with severity of vessel restenosis, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=120.7, 124.9, 107.5, 127.1; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with in-stent restenosis (100%) were (0.3±0.2)%, (3.3±1.3) ng/L, (1.1±0.8) ng/L, (15.1±10.8) μmol/L, lower than that in patients with in-stent restenosis (90%-99%)[(1.1±0.4)%, (5.3±2.7) ng/L, (2.0±0.5) ng/L, (27.8±12.9) μmol/L], the differences were statistically significant(with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in patients with in-stent restenosis (100%) were lower than in patients with in-stent restenosis (70%-89%) and the control group, the differences were statistically significant(with P values below 0.05). (3) With the decrease of LVEF, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=663.0, 1599.0, 720.0, 2188.4; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in the LVEF 25%-36% group were lower than other groups significantly, the differences were statistically significant(with P values below 0.05). (4) Along with the decrease of NYHA, the levels of EPC, SDF-1α, VEGF and NO were decreased, the differences were statistically significant(F=135.1, 118.2, 175.6, 115.2; with P values below 0.05). The levels of EPC, SDF-1α, VEGF and NO in the patients with NYHA Ⅳ group were lower than other groups significantly, the differences were statistically significant(with P values below 0.05). Conclusion EPC, SDF-1α, VEGF and NO may be used as the new diagnostic makers for restenosis after primary coronary stent implantation in elderly patients with old myocardial infarction. Key words: Coronary restenosis; Coronary occlusion; Stents; Myocardial infarction; Diagnosis; Aged; Marker