The Inflammatory Response to Percutaneous Coronary Intervention is Related to Myocardial Injury in Patients with Chronic Ischemic Heart Disease

Introduction: In the setting of acute coronary syndromes, the association between a major release of both multiple inflammatory and myocardial injury markers after PCI is linked with a subsequent poor prognosis. However, little is known concerning the association between these markers in stable patients. Objective: We aimed to describe the association between systemic inflammatory response and myocardial injury after percutaneous coronary intervention (PCI) in patients with chronic ischemic heart disease (CIHD). C-reactive protein (CRP) and hematological indices were assessed to depict inflammation. Methods: In this retrospective, observational study, blood samples were taken before and 48 hours after successful PCI in 329 patients (65.3±11.7 y, 67% men) with CIHD. Inflammatory markers (IM) were determined: CRP, white blood cells (WBC) and subtypes, platelets, mean platelet volume (MPV), neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR). High-sensitivity cardiac troponin I (hs-cTnI) was measured post-PCI. Procedural myocardial injury was arbitrarily defined by increases of hs-cTnI values and no new electrocardiographic changes nor flow-limiting complications. Results: PCI produced a systemic inflammatory response with a rise in IM levels. 66.7% of the patients presented myocardial injury. To determine the strength and direction of the association between increased IM and hs-cTnI, Spearman's rank-order correlation was determined: CRP 0.570 (p<0.001), NLR 0.190 (p<0.001), MPV 0.182 (p<0.001), PLR 0.180 (p<0.001), WBC 0.166 (p<0.001), neutrophils 0.145 (p<0.001), eosinophils 0.142 (p<0.001), lymphocytes -0.130 (p<0.001), monocytes 0.031 (p=0.344), and platelets -0.009 (p=0.778). Conclusion: Thus, PCI in patients with CIHD induces a systemic inflammatory reaction, which is associated with burden of procedural myocardial injury.