Integrity® bare-metal coronary stent-induced platelet and endothelial cell activation results in a higher risk of restenosis compared to Xience® everolimus-eluting stents in stable angina patients

Tibor Szük, Zsolt Fejes, Ildikó Beke Debreceni, Adrienne Kerényi, I. Édes, J. Kappelmayer, B. Nagy

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalPlatelets
DOIs
Publication statusAccepted/In press - Jan 16 2016

Fingerprint

Stable Angina
Stents
Blood Platelets
Endothelial Cells
Metals
P-Selectin
Pharmaceutical Preparations
Platelet-Derived Growth Factor
Platelet Activation
Thrombosis
CD40 Ligand
E-Selectin
Vascular Cell Adhesion Molecule-1
Platelet Aggregation Inhibitors
von Willebrand Factor
Intercellular Adhesion Molecule-1
Endothelium
Blood Vessels
Everolimus
Biomarkers

Keywords

  • Coronary stenting
  • endothelial injury
  • inflammation
  • platelet activation
  • soluble marker
  • therapeutic responsiveness

ASJC Scopus subject areas

  • Hematology

Cite this

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title = "Integrity{\circledR} bare-metal coronary stent-induced platelet and endothelial cell activation results in a higher risk of restenosis compared to Xience{\circledR} everolimus-eluting stents in stable angina patients",
abstract = "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{\circledR}, Abbott Vascular, Santa Clara, CA, USA) or BMS (Integrity{\circledR}, 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{\circledR} DES may be regarded a safer coronary intervention than Integrity{\circledR} BMS, with a lower risk of in-stent restenosis.",
keywords = "Coronary stenting, endothelial injury, inflammation, platelet activation, soluble marker, therapeutic responsiveness",
author = "Tibor Sz{\"u}k and Zsolt Fejes and Debreceni, {Ildik{\'o} Beke} and Adrienne Ker{\'e}nyi and I. {\'E}des and J. Kappelmayer and B. Nagy",
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T1 - Integrity® bare-metal coronary stent-induced platelet and endothelial cell activation results in a higher risk of restenosis compared to Xience® everolimus-eluting stents in stable angina patients

AU - Szük, Tibor

AU - Fejes, Zsolt

AU - Debreceni, Ildikó Beke

AU - Kerényi, Adrienne

AU - Édes, I.

AU - Kappelmayer, J.

AU - Nagy, B.

PY - 2016/1/16

Y1 - 2016/1/16

N2 - 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.

AB - 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.

KW - Coronary stenting

KW - endothelial injury

KW - inflammation

KW - platelet activation

KW - soluble marker

KW - therapeutic responsiveness

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DO - 10.3109/09537104.2015.1112368

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