Objective: To assess the different effects of inflammation and lipid levels before and after PCI on in-stent restenosis and lesion progression.
Methods: Patients were studied who successfully underwent PCI with stent implantation and were received coronary angiography again after three months to one year. In-stent restenosis was observed in 94 patients and lesion progression in 65 patients. No restenosis and lesion progression occurred in 307 cases. Total cholesterol (TC), total triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), C reactive protein (CRP) and high sensitive CRP (hsCRP) were determined before PCI and at time of re-angiography.
Results: The levels of CRP and hsCRP before PCI in restenosis group were higher than those with no restenosis (CRP: median = 3.61 mg/L and 2.86 mg/L respectively, hsCRP: median = 1.56 mg/L and 0.89 mg/L respectively, P < 0.05). There was also difference between two groups in CRP levels at post-PCI follow-ups (median = 1.92 mg/L and 1.14 mg/L respectively, P < 0.05). The rate of restenosis in patients with hsCRP > 2 mg/L before PCI was higher than that in patients with hsCRP < or = 2 mg/L (Chi(2) = 4.32, P < 0.05). Logistic regression showed that the risk of restenosis markedly increased in patients with hsCRP > 2 mg/L (OR = 1.89, 95% CI 1.031-3.465). During the follow-up angiography the levels of TC, LDL-C and non-HDL-C were higher in lesion progression group than those in control group [TC (4.62 +/- 1.14) mmol/L and (4.26 +/- 1.01) mmol/L, LDL-C (2.51 +/- 0.93) mmol/L and (2.25 +/- 0.75) mmol/L, non-HDL-C (3.52 +/- 1.12) mmol/L and (3.20 +/- 0.98) mmol/L, respectively, P < 0.05).
Conclusion: Inflammation state before and after PCI are the risk factors for in-stent restenosis, while the levels of TC, LDL-C and non-HDL-C are the important risk factors for other coronary lesion progression. Secondary prevention should be long-term emphasized and strengthened after PCI.