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.