The Evolving Role of Inflammatory Biomarkers in Risk Assessment After Stent Implantation
The Evolving Role of Inflammatory Biomarkers in Risk Assessment After Stent Implantation
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DOI：
10.1016/j.jacc.2010.06.045
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发表时间：
2010-11-23
影响因子：
24
通讯作者：
Crea, Filippo
中科院分区：
文献类型：
--
作者：
Niccoli, Giampaolo;Montone, Rocco A.;Crea, Filippo
冠脉支架的主要不良反应是支架内再狭窄（ISR）和支架内血栓形成。除程序性因素外，个体对这些事件的易感性也起着重要作用。特别是，通过c反应蛋白水平评估的炎症状态预测裸金属支架植入术后ISR的风险，尽管它不能预测支架血栓形成的风险。相反，c反应蛋白水平不能预测药物洗脱支架（DES）植入后ISR的风险，尽管它们似乎可以预测支架血栓形成的风险。值得注意的是，在经典的1年窗口期，DES降低了ISR发生率，但新的关注出现在晚期再狭窄和血栓形成方面。这些晚期事件的发病机制似乎与延迟愈合和对聚合物的过敏反应有关，在这一过程中，嗜酸性粒细胞似乎通过增强再狭窄和血栓形成发挥重要作用。基于生物标志物评估的高危个体的识别可能对支架植入术患者的管理很重要。在本报告中，我们回顾了炎症生物标志物在预测ISR和支架血栓形成风险中的作用。[J]中华医学会心脏科杂志，2010;56 (6):893 - 893 . [C] 2010
The main adverse reactions to coronary stents are in-stent restenosis (ISR) and stent thrombosis. Along with procedural factors, individual susceptibility to these events plays an important role. In particular, inflammatory status, as assessed by C-reactive protein levels, predicts the risk of ISR after bare-metal stent implantation, although it does not predict the risk of stent thrombosis. Conversely, C-reactive protein levels fail to predict the risk of ISR after drug-eluting stent (DES) implantation, although they appear to predict the risk of stent thrombosis. Of note, DES have abated ISR rates occurring in the classical 1-year window, but new concern is emerging regarding late restenosis and thrombosis. The pathogenesis of these late events seems to be related to delayed healing and allergic reactions to polymers, a process in which eosinophils seem to play an important role by enhancing restenosis and thrombosis. The identification of high-risk individuals based on biomarker assessment may be important for the management of patients receiving stent implantation. In this report, we review the evolving role of inflammatory biomarkers in predicting the risk of ISR and stent thrombosis. (J Am Coll Cardiol 2010;56:1783-93) (C) 2010 by the American College of Cardiology Foundation