Nil ÖZYÜNCÜ, Hasan Sadi GÜLEÇ, Hüseyin GÖKSÜLÜK, Özgür Ulaş ÖZCAN, Çetin EROL, Demet Menekşe GEREDE ULUDAĞ

Çıplak Metal Stentler ve İlaç Salınımlı Stentlerin C-Reaktif Protein Düzeyleri Üzerine Etkilerinin Karşılaştırılması

Amaç: İlaç salınımlı stentlerin (İSS) sistemik anti-enflamatuvar özelliklerinin olabileceği ve bunun restenoz oranlarındaki düşüşte rol oynayabileceğiiddia edilmektedir. Amacımız, çıplak metal stentler (ÇMS) ile ilaç salınımlı stentleri sistemik enflamasyonun iyi bir göstergesi olan C-reaktif protein(CRP) düzeyleri üzerine etkileri açısından karşılaştırmaktı. Ayrıca enflamasyon düzeyi ile miyonekroz ve istenmeyen kardiyak olaylar arasındakiilişkinin araştırılması da amaçlandı.Gereç ve Yöntem: Elektif koroner stent uygulanan hastalar stent tipine göre ÇMS (n=70) ve İSS gruplarına (n=42) ayrıldı. Bazal ve işlem sonrası 24.saatteki CRP ve CK-MB düzeyleri ölçülerek aradaki fark (delta=Δ) gruplar arasında kıyaslandı. Hastalar bir yıl boyunca istenmeyen kardiyak olaylar(ölümcül olmayan miyokart enfarktüsü, ölüm ve hedef damar revaskülarizasyonu) açısından takip edildi.Bulgular: Hastaların yaş ortalaması 62±11 olup %75’i erkek idi. Her iki stent grubunda da 24. saatte anlamlı düzeyde CRP artışı olmasına rağmenΔCRP, ÇMS grubunda 2,1 (0,5-6,2) mg/L, İSS grubunda ise 2,3 (0,2-5,2) mg/L olup iki grup arasında anlamlı fark saptanmadı (p=0,703). Her iki stentgrubunda ΔCK-MB ve majör kardiyak olay sıklığı benzerdi (p=0,897 ve p=0,785). ΔCRP ile ΔCK-MB arasında her iki stent grubunda da anlamlıkorelasyon bulunmadı (ÇMS için r=-0,090 ve p=0,459, İSS için r=0,158 ve p=0,318). Benzer şekilde ΔCRP’nin istenmeyen kardiyak olay sıklığı üzerineetkisi de anlamlı değildi (ÇMS için p=0,349 ve İSS için p=0,135).Sonuç: Bulgularımız ÇMS ve İSS uygulanan hastalarda işlem sonrası benzer düzeyde sistemik enflamatuvar yanıt oluştuğunu göstermektedir. Benzersistemik enflamasyon düzeyleri altında İSS ile sağlanan restenoz oranlarındaki düşüşte, bu stentlerin lokal anti-enflamatuvar özellikleri rol oynuyorolabilir.

Comparison of the Effects of Bare Metal Stents and Drug Eluting Stents on C-Reactive Protein Levels

Objectives: It is suggested that drug eluting stents (DES) may have systemic anti-inflammatory properties and this can play a role in decreased restenosis rates. We aimed to compare bare metal stents (BMS) and DES for their effects on C-reactive protein (CRP) levels, a good marker of systemic inflammation. We also aimed to investigate the relationship between the inflammation levels and myonecrosis and adverse cardiac events. Materials and Methods: Patients undergoing elective stent implantation were grouped as BMS (n=70) and DES (n=42). Basal and 24th hour postprocedural CRP and creatine kinase-MB (CK-MB) levels were measured and the difference (delta=Δ) was compared between the groups. The patients were followed up for adverse cardiac events for one year. Results: The mean age was 62±11 years and 75% were males. There was significant CRP rise in both groups at the 24th hour, but the ΔCRP was 2.1 (0.5-6.2) mg/L in the BMS group and 2.3 (0.2-5.2) mg/L in the DES group, the difference was not statistically significant (p=0.703). ΔCK-MB and adverse cardiac event rates were similar between the two groups (p=0.897 and p=0.785). There was no correlation between ΔCRP and ΔCK-MB (r=-0.090 and p=0.459 for BMS, r=0.158 and p=0.318 for DES). The effect of ΔCRP on the incidence of adverse cardiac events was not significant (p=0.349 for BMS, p=0.135 for DES). Conclusion: Our findings reveal that patients with BMS and DES implantation exhibit similar grade of systemic inflammation after the procedure. At similar levels of systemic inflammation, the local anti-inflammatory properties of DES can play a role at decreased restenosis rates.

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