Abstract 809: Pentraxin 3 (PTX3) as a Novel Marker for Stent-induced Inflammation and Coronary Restenosis
Objectives: Inflammation in the vessel wall plays an essential role in the process of atherogenesis, plaque vulnerability, and restenosis after percutaneous coronary intervention. Unlike classic short pentraxin CRP is produced mainly by the liver, prototypic member of the long-pentraxin family Pentraxin3 (PTX3) is synthesized at the inflammatory site by monocytes, macrophages, smooth muscle cells, and endothelial cells in response to primary inflammatory stimuli, including oxidized LDLs. It has been described that PTX3 is present in advanced atherosclerotic lesions and its plasma concentration is increased in acute myocardial infarction or human vasculitis, therefore it is called ‘vessel-related pentraxin’. The aim of the present study was to establish the clinical significance of plasma PTX3 level measured by ELISA in pathophysiology of the inflammatory process after coronary stent implantation.
Methods and Results: We serially measured plasma PTX3 level as well as high-sensitivity (hs)-CRP and activated Mac-1 on the surface of neutrophils in 20 patients undergoing elective coronary stent implantation. Plasma PTX3 level was significantly increased 15 min after coronary stent implantation, and was shown to peak at 24 hrs both in coronary sinus and peripheral blood (3.39±1.98 to 8.52±3.88 ng/ml, 3.62±2.20 to 8.60±3.25 ng/ml, P<0.001, respectively). Transcardiac PTX3 gradient (0.40±0.64 V.S. −0.19±0.33 ng/ml, P=0.02, at 15 min) and relative increase in PTX3 (349.6±179.8 V.S. 151.2±90.6 %, P=0.01, at 24 hrs) in coronary sinus was significantly higher in 6 patients who experienced restenosis than in remaining 14 who did not, and later was correlated with that in hs-CRP (R=0.65, P<0.01) and activated Mac-1 (R=0.52, P<0.05) at 48 hrs. Multiple regression analysis that included variables obtained from quantitative coronary angiography and peripheral blood sample demonstrated that relative increase in PTX3 at 48 hrs was the most powerful predictor of late lumen loss (standard regression coefficient 0.547, P<0.01).
Conclusions: Coronary stenting enhanced circulating PTX3 level in association with an inflammatory response. PTX3 may be a useful marker for evaluation of stent-induced Mac-1-mediated inflammatory reaction.