Differences in the Inflammatory Response between Patients with and Those without Diabetes Mellitus after Coronary Stenting
Article first published online: 13 AUG 2008
©2008, the Authors Journal compilation ©2008, Wiley Periodicals, Inc.
Journal of Interventional Cardiology
Volume 21, Issue 5, pages 403–409, October 2008
How to Cite
PAIVA, M. S. M. O., SERRANO, Jr, C. V., NICOLAU, J. C., JALBUT, B. O., FERNANDES, J. L., DE LEMOS, J. A., BLOTTA, M. H. S. L., DE OLIVEIRA, R. T. D., DE OLIVEIRA, I. R., DE OLIVEIRA, L. D. A. R. R. and RAMIRES, J. A. F. (2008), Differences in the Inflammatory Response between Patients with and Those without Diabetes Mellitus after Coronary Stenting. Journal of Interventional Cardiology, 21: 403–409. doi: 10.1111/j.1540-8183.2008.00385.x
- Issue published online: 24 SEP 2008
- Article first published online: 13 AUG 2008
Background: Patients with diabetes mellitus who undergo coronary stenting are at increased risk of restenosis. It is known that inflammation plays a crucial role in restenosis.
Objective: We assessed the inflammatory response to elective coronary stent implantation (CSI) in stable diabetic and nondiabetic patients.
Methods: C-reactive protein (CRP), soluble (s) P-selectin, and soluble intercellular adhesion molecule (sICAM)-1 plasma levels were determined in diabetic (n = 51) and nondiabetic (n = 56) patients before and 48 hours and 4 weeks after bare metal stenting (BMS).
Results: Diabetic patients presented significantly higher inflammatory marker levels before and after CSI. Nonetheless, diabetic and nondiabetic patients had postintervention peak of markers attained within 48 hours. At baseline, diabetic and nondiabetic patients presented CRP levels of 5.0 ± 20.1 (P ≤ 0.04) and 3.8 ± 9.4 μg/ml and, at 48 hours postintervention, 22.0 ± 20.2 (P = 0.001; P = 0.002) and 12.6 ± 11.3 (P ≤ 0.0001) μg/ml. Regarding sP-selectin, diabetic and nondiabetic patients obtained levels of, at baseline, 182 ± 118 (P ≤ 0.04) and 105 ± 48 ng/ml and, at 48 hours, 455 ± 290 (P = 0.001; P ≤ 0.01) and 215 ± 120 (P ≤ 0.04) ng/ml. For diabetic and nondiabetic patients, sICAM-1 levels were, at baseline, 248 ± 98 (P ≤ 0.04) and 199 ± 94 ng/ml and, at 48 hours, 601 ± 201 (P = 0.001; P ≤ 0.01) and 283 ± 220 (P = 0.001) ng/ml. At 4 weeks, for all patients, markers returned to preprocedural levels: versus before PCI: *P = 0.001, §P ≤ 0.0001; versus nondiabetic patients: #P ≤ 0.04, ¶P = 0.002, ϒP ≤ 0.01.
Conclusions: Diabetic and nondiabetic patients exhibited a temporal inflammatory response after an elective BMS. However, diabetic patients present higher preprocedural levels of CRP, sP-selectin, and sICAM-1 and reveal a further exacerbated inflammatory response after intervention. The differences in inflammatory response may have implications in restenosis within these two sets of patients.