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Open Access Original investigation

Coronary aspirate TNFα reflects saphenous vein bypass graft restenosis risk in diabetic patients

Theodor Baars1, Thomas Konorza2, Philipp Kahlert2, Stefan Möhlenkamp3, Raimund Erbel2, Gerd Heusch1 and Petra Kleinbongard1*

Author Affiliations

1 Institut für Pathophysiologie, Universitätsklinikum Essen, Hufelandstr. 55, 45122, Essen, Germany

2 Klinik für Kardiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Essen, Germany

3 Krankenhaus Bethanien Moers, Moers, Germany

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Cardiovascular Diabetology 2013, 12:12  doi:10.1186/1475-2840-12-12

Published: 10 January 2013

Abstract

Background

Patients with diabetes mellitus (DM) have an increased risk for periprocedural complications and adverse cardiac events after percutaneous coronary intervention. We addressed the potential for coronary microvascular obstruction and restenosis in patients with and without DM undergoing stenting for saphenous vein bypass graft (SVG) stenosis under protection with a distal occlusion/aspiration device.

Methods

SVG plaque volume and composition were analyzed using intravascular ultrasound before stent implantation. Percent diameter stenosis was determined from quantitative coronary angiography before, immediately after and 6 months after stent implantation. Coronary aspirate was retrieved during stent implantation and divided into particulate debris and plasma. Total calcium, several vasoconstrictors, and tumor necrosis factor (TNF)α in particulate debris and coronary aspirate plasma were determined.

Results

Patients with and without DM had similar plaque volume, but larger necrotic core and greater particulate debris release in patients with than without DM (20.3±2.7 vs. 12.7±2.6% and 143.9±19.3 vs. 75.1±10.4 mg, P<0.05). The TNFα concentration in particulate debris and coronary aspirate plasma was higher in patients with than without DM (15.9±6.6 vs. 5.1±2.4 pmol/mg and 2.2±0.7 vs. 1.1±0.2 pmol/L, P<0.05), whereas total calcium and vasoconstrictors were not different. Patients with DM had a greater percent diameter stenosis 6 months after stent implantation than those without DM (22.17±5.22 vs. 6.34±1.11%, P<0.05). The increase in TNFα immediately after stent implantation correlated with restenosis 6 months later (r=0.69, P<0.05).

Conclusion

In diabetics, particulate debris and coronary aspirate plasma contained more TNFα, which might reflect the activity of the underlying atherosclerotic process.

Trial registration

URL: http://www.clinicaltrials.gov/ct2/results?term=NCT01430884 webcite; unique identifier: NCT01430884

Keywords:
Coronary disease; Diabetes mellitus; Ischemia; TNFα; Vasoconstriction