| 강웅철¹, 문찬일¹ , 한승환¹ , 안태훈¹ , 신익균¹ ,김병극² , 오성진² , 전동운² , 양주영² , 김중선³ , 고영국³, 최동훈³, 장양수³ |
Introduction Inflammation plays a crucial role in determining in-stent restenosis via neointimal proliferation. Although DES reduce restenosis by inhibition of neointimal hyperplasia (NIH), paclitaxel-eluting stent (PES) and silorimus-eluting stent (SES) showed different effect on suppression of NIH in several studies. So we compared degree of inflammation, as measured by plasma CRP, IL-6 levels and NIH volume after PES and SES implantation. Method This study of sub-study of the POET trial. We performed PCI with a single DES in 79 stable angina patients (47 men; 60.4±9,7 years of age; PES group, n=41; SES group, n=38). Plasma CRP and IL-6 levels were determined before PCI and at 24, 72 hours, 4 weeks and 9 months after PCI. IVUS study was also performed at pre, post PCI and follow-up angiography at 9 months after PCI. Results There was no difference in clinical and angiographic baseline characteristics between both groups. Although plasma CRP and IL-6 levels at baseline were not different between both groups (3.25±2.57 vs 3.18±2.43 mg/L, p=0.898, 3.13±4.45 vs 3.61±3.46 pg/mL, p=0.617), NIH volume at 9 months after PCI is significantly higher in PES group rather than to SES group (22.9±22.1 vs 3.8±7.1 mm3, p=0.000). Plasma CRP, IL-6 levels at 24 hours (6.76±6.90 vs 7.03±6.66 mg/L, p=0.863, 9.70±8.46 vs 12.01±15.25 pg/mL, p=0.462) and 72 hours (7.78±6.83 vs 7.73±6.74 mg/L, p=0.973, 3.28±2.17 vs 4.62±3.89 pg/mL, p=0.104) after PCI were not also different between both groups. At 4 weeks after PCI, plasma IL-6 levels tend to higher in PES group rather than in SES group, there was no statistical significance (1.60±1.15 vs 2.97±3.55 pg/mL, p=0.068). At 9 months after PCI, there were no different in both markers between both groups. Conclusions Although NIH volume at follow-up IVUS study was lower in SES group rather than PES group, SES did not show significantly lower plasma CRP and IL-6 levels compared to PES after PCI at any stage. This study suggested that other factors, such as mechanical or pharmacokinetic properties rather than anti-inflammatory reaction of DES, may play a more crucial role in suppression of NIH after DES implantation.
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