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Coronary artery bypass surgery after stent implantation: assessment of inflamatory activity and gene expression

Grant number: 11/09276-3
Support type:Regular Research Grants
Duration: November 01, 2011 - October 31, 2013
Field of knowledge:Health Sciences - Medicine - Surgery
Principal Investigator:Pedro Silvio Farsky
Grantee:Pedro Silvio Farsky
Home Institution: Instituto Dante Pazzanese de Cardiologia (IDPC). Fundação Adib Jatene (FAJ). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Patients undergoing coronary artery bypass grafting (CABG) may have its short and long term committed by previous percutaneous coronary intervention (PCI). There are studies showing increased mortality in patients undergoing CABG with prior PCI, in-hospital and long term. However, more recent studies do not corroborate this fact. It is unclear whether stents compromise the outcome after CABG. It described a local inflammatory reaction at the site of coronary stenting and changes in platelet aggregation. Analysis of fragments removed distal to coronary stent implantation at the site of the anastomosis during coronary artery bypass surgery showed an inflammatory process in the intima and media, ranging from mild to intense. Analysis after 18 months of stent implantation still showed an inflammatory infiltrate the intima, the presence of polymorphonuclear cells. The pathophysiological mechanisms for this are not fully understood and need further investigation. This study aims to evaluate the inflammatory activity in coronary artery bypass grafting after percutaneous coronary intervention with stents. This will include 100 patients hospitalized for MCR, with and without previous coronary stent implantation. During the surgery will be taken from a fragment of the artery prior to stenting and another fragment of another artery without stent implantation, and patients without a history of stent implantation. This fragment will be about 1x1 mm, taken from the edge of the site of arteriotomy for anastomosis of the graft. This fragment will be used for immunohistochemical analysis. Will be analyzed mRNA expression of genes LIGHT, IL-6, ICAM1, VCAM-1, CD40, NFkB, CRP, TNF-± and IFN in peripheral blood. Will be made iminolocalização proteins IL-6, ICAM1, VCAM-1, CD40, NFkB, CRP, TNF-± and IFN-³ for later comparison with the quantification in peripheral blood. All tests will be conducted at the Laboratory of Molecular Biology and Pathological Anatomy sector, both from the Institute Dante Pazzanese of Cardiology. (AU)