Abstract 13740: Significance of Chronic Low-Grade Inflammation and Diabetes Mellitus (DM) for Coronary Spasm Following Drug-Eluting Stent Implantation in Patients with Coronary Heart Disease (CHD)

Background: Coronary spasm is a manifestation of coronary endothelial dysfunction characterized by transient total or subtotal occlusion or severe diffuse vasoconstriction of an epicardial artery and contributes importantly to the pathogenesis of coronary heart disease (CHD). Coronary spasm and diabetes mellitus (DM) are reported to be associated with low-grade inflammation. However, it is unknown about the relation between chronic inflammation and DM in atherosclerotic high-risk patients following drug-eluting stent (DES) implantation. The aim was to examine the relation between coronary spasm and chronic inflammation or DM. Methods: We performed intracoronary acetylcholine test for coronary spasm provocation in 60 consecutive patients (41 male, age 69.1±9.1yrs) who had underwent new generation DES (cobalt-chromium everolimus-eluting stent, Xience (n=33); or biolimus-eluting stent, Nobori (n=27)) in left ascending coronary artery at 9 months before and examined plasma levels of tumor necrosis factor (TNF) α, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hs-CRP) in the chronic phase without acute inflammation findings. Patients were divided into 3 groups: presence of both coronary spasm and DM (n=18), presence of each spasm or DM (n=31), and non-spasm and non-DM (n=11). Results: Coronary spasm was induced in 31 (51.6%) of 60 patients. Levels of TNFα, IL-6, and hs-CRP in spasm and DM group were increased compared with those in non-spasm and non-DM group (TNFα; 2.123±0.441 vs. 1.267±0.079 pg/ml, P=0.073: IL-6; 2.668±0.429 vs. 1.346±0.241 pg/ml, P=0.039: hs-CRP; 0.183±0.208 vs. 0.058±0.042 mg/dl, P=0.037). Levels of TNFα, IL-6, and hs-CRP in the each spasm or DM group were in between spasm / DM group and non-spasm / non-DM group, respectively (TNFα, 1.901±0.841pg/ml; IL-6, 2.125±0.651pg/ml; hs-CRP; 0.091±0.073mg/dl). Coronary spasm was not induced in statin-users among the total patients, and non-use of statin was associated with positive for coronary spasm (P=0.041) and increased inflammation levels. Conclusions: Coexistence of coronary spasm and DM in the chronic phase after new generation DES implantation may be associated with low-grade inflammation. The prevention of coronary spasm is related to the use of statin.