1Mohammad A. Sweilam, 1Amany A. Enien, 1Said H. Abdou, 1Amal El Bendary, 2Seham Badr
Departments of 1Clinical pathology and 2Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt.
Inflammatory response is considered an important mechanism in atherosclerosis and post percutaneous transluminal coronary angioplasty (PTCA) (with or without stent implantation) restenosis. It has been suggested that infectious factors may be implicated in restenosis process. The aim of the study was to investigate the link between C- reactive protein (CRP), serum Amyloid A protein (SAA), interleukin 6 and 1β expression (IL6, IL-1β) and previous infection with Helicobacter pylori (H. pylori) and restenosis after coronary stent implantation. The study involved 30 patients with ischemic heart disease who underwent PTCA with stent implantation. Blood samples were drawn before and 24 hrs after stent implantation to measure levels of CRP, SAA, while IL-6, IL-1 β gene expression in coronary sinus were measured by RT-PCR before and immediately after PTCA and previous infection with H. pylori infection was identified by IgG antibody determination. Patients were scheduled for follow up angiography six months after stent implantation. Quantitative coronary angiography was used to assess the late lumen loss. The patients were divided into two groups according to late restenosis criteria at follow up angiography. 19 patients with no restenosis and 11 patients with restenosis. Patients with restenosis had a higher levels of CRP (2.01 Vs 0.26 mg/dl, P < 0.001) and SAA (5.00 vs 0.35 mg/dl P <0.001) as compared with patients without restenosis. Also IL-6 and IL-1 β expression were significantly higher in patients with restenosis than in those without restenosis (2.63 vs 1.8 and 2.28 vs 1.72 pmol-Eq/µg RNA respectively, P<0.05). There was a positive correlation between CRP, SAA levels concentration and IL-6, IL-1 β expression after stent implantation and late lumen loss at six months follow up (r= 0.62, 0.59, 0.71, 0.65, respectively, p<0.001 ), meanwhile there was no link between previous H. pylori infection and late lumen loss (r= 0.24, p>0.05). Accuracy of CRP, SAA, IL-1 β and IL-6 expression and late lumen loss were 66.65, 71.4%, 81.45%, 95.25% respectively. We can concluded that systemic markers of inflammation such as CRP, SAA levels and IL-6 and IL-1 β expression may play an important role in late restenosis after coronary stent implantation however previous infection with H. pylori may not be a contributing factor in the process of restenosis.