Szük Tibor, Fejes Zsolt, Debreceni Ildikó Beke, Kerényi Adrienne, Édes István, Kappelmayer János, Nagy Béla
a Institute of Cardiology.
b Department of Laboratory Medicine, Faculty of Medicine , University of Debrecen , Debrecen , Hungary.
Platelets. 2016 Jul;27(5):410-9. doi: 10.3109/09537104.2015.1112368. Epub 2016 Jan 14.
Drug-eluting stenting (DES) has become a reliable tool for coronary stenting; however, its direct effects on platelet and endothelium function differ from those of bare-metal stenting (BMS). This study involved a periprocedural analysis of various biomarkers of cellular activation after elective DES (Xience(®), Abbott Vascular, Santa Clara, CA, USA) or BMS (Integrity(®), Medtronic, Minneapolis, MI, USA). Forty-nine stable angina patients were recruited: 28 underwent BMS, and 21 received everolimus-eluting stents. Samples were collected (i) prior to stenting, (ii) at 24 hours after procedure, and (iii) after 1 month of dual antiplatelet therapy. Platelet activation was analyzed by surface P-selectin positivity in parallel with plasma levels of soluble P-selectin, CD40L and platelet-derived growth factor (PDGF). Endothelial cell (EC) activation was detected by measuring markers of early (von Willebrand factor) and delayed response (VCAM-1, ICAM-1, E-selectin). Patients were followed for 6 months for the occurrence of restenosis or stent thrombosis. Increased platelet activation was sustained regardless of stent type or antiplatelet medication. Concentrations of most EC markers were more elevated after BMS than after DES. No stent thrombosis was seen, but six BMS subjects displayed restenosis with significantly higher sCD40L (779 [397-899] vs. 381 [229-498] pg/mL; p = 0.032) and sICAM-1 (222 [181-272] vs. 162 [153-223] ng/mL; p = 0.046) levels than in those without complication, while DES patients exhibited significantly decreased PDGF (572 [428-626] vs. 244 [228-311] pg/mL; p = 0.004) after 1 month. Nonresponsiveness to antiplatelet drugs did not influence these changes. In conclusion, the degree of platelet and EC activation suggests that Xience(®) DES may be regarded a safer coronary intervention than Integrity(®) BMS, with a lower risk of in-stent restenosis.
药物洗脱支架置入术（DES）已成为冠状动脉支架置入的可靠工具；然而，其对血小板和内皮功能的直接影响与裸金属支架置入术（BMS）不同。本研究对择期DES（Xience(®)，美国雅培血管公司，加利福尼亚州圣克拉拉）或BMS（Integrity(®)，美敦力公司，明尼苏达州明尼阿波利斯）术后细胞活化的各种生物标志物进行了围手术期分析。招募了49例稳定型心绞痛患者：28例行BMS，21例接受依维莫司洗脱支架。在（i）支架置入前、（ii）术后24小时以及（iii）双联抗血小板治疗1个月后采集样本。通过表面P-选择素阳性并结合血浆可溶性P-选择素、CD40L和血小板衍生生长因子（PDGF）水平分析血小板活化情况。通过测量早期（血管性血友病因子）和延迟反应（VCAM-1、ICAM-1、E-选择素）标志物检测内皮细胞（EC）活化情况。对患者随访6个月，观察再狭窄或支架血栓形成情况。无论支架类型或抗血小板药物如何，血小板活化均持续增加。大多数EC标志物的浓度在BMS术后比DES术后升高更明显。未观察到支架血栓形成，但6例BMS患者出现再狭窄，其sCD40L（779 [397 - 899] vs. 381 [229 - 498] pg/mL；p = 0.032）和sICAM-1（222 [181 - 272] vs. 162 [153 - 223] ng/mL；p = 0.046）水平显著高于无并发症患者，而DES患者在1个月后PDGF水平显著降低（572 [428 - 626] vs. 244 [228 - 311] pg/mL；p = 0.004）。抗血小板药物无反应性并不影响这些变化。总之，血小板和EC活化程度表明，与Integrity(®) BMS相比，Xience(®) DES可能是一种更安全的冠状动脉介入治疗方法，支架内再狭窄风险更低。
