| Acute myocardial infarction (AMI) is that the myocardium of which blood supply suddenly reduced or interrupted based on the coronary artery lesion have been ischemic and necrosis. In acute stage, the mortality of the patients with AMI who didn't treated by reperfusion strategies is12% to 14%, which higher than that who did. Consequently, The reperfusion strategies which can recover the blood supply is especially important. From Sigwart first coronary stent implantation used in clinical in 1986,the primary percutaneous coronary intervention (PCI) are the main and effective reperfusion strategy, which can recover the blood supply of the infarcted myocardium quickly and effectively, degrade the mortality of the patients with AMI, improve prognosis of these patients. Coronary stent implantation avoid such as vascular recoil,vascular remodeling early in the mechanism of restenosis,to ensure immediate effect after stenting and reduced the restenosis rate compared with PTCA,In the bare stent era Restenosis rate is still 20% -30%。Are of the view that restenosis, including three relatively independent and associated links, that is, thrombosis, intimal hyperplasia and vascular remodeling. Stent so that the integrity of vascular endothelial cell damage, resulting in subendothelial matrix exposed to the blood, which triggered platelet cohesion, adhesion and then platelet-rich thrombus formation, which is early vascular injury after stenting the pathophysiological process of . Since then, the progressive machine with thrombosis, and intimal hyperplasia in restenosis formation of a leading role. Mainly refers to intimal hyperplasia of vascular smooth muscle cells (VSMC) in a variety of growth factors and vasoactive substances stimulated to begin by the middle to the arterial intimal migration, proliferation and secretion of extracellular matrix at the same time to form the neointima (neointima, NI ) process. Mainly in the vascular remodeling of late restenosis play a role in the formation of advanced middle vessel wall hyperplasia in a large number of fibrous tissue, so that the vessel wall sclerosis, lower compliance, and promoted the occurrence of restenosis. In recent years, a variety of drug-eluting stents, intracoronary radiation therapy, gene therapy research, as well as oral medication, in order to address restenosis has brought new hope. Stent carrying drugs inhibit VSMC proliferation, inhibited neointimal hyperplasia, thereby further reducing the incidence of restenosis. Stent which carry the drugs inhibit VSMC proliferation can inhibit neointimal hyperplasia,accordingly reducing the incidence of restenosis。The application of Drug-eluting stent (drug-eluting stent, DES) in the history of percutaneous coronary intervention is a major breakthrough。A number of large-scale clinical trials show that the Drug-eluting stent restenosis rate reduced to 10% or less。However, eluting stents increase the risk of thrombosis, Clinical trials is not found reduce incidence of mortality and the acute myocardial infarction,so the choice of stent is still controversial.After coronary stent implantation the mechanism of RS includ a number of aspects。People from the occurrence of RS sites to observe the morphology of the inflammatory cytokines, such as the detection of micro-level inflammatory response have found evidence of participation in RS。Many Stent restenosis were found related to the increase of inflammatory factors. Inflammatory factor is defined as the process of inflammation produced by inflammatory cells and secretion of substances involved in inflammatory, Including IL-6, C-reactive protein, monocyte chemoattractant protein, soluble intercellular adhesion factor, etc, Which macrophage colony-stimulating factor M-CSF is an important inflammatory response of inflammatory cytokines, the level of inflammatory response may reflect the strength of the body, is a reflection of coronary heart disease in patients with PCI Bank in particular, indicators of prognosis, and after PCI restenosis (restenosis , RS) related. M-CSF can monocyte-macrophage accumulation in the vessel wall, but also through its receptor cause damage to the endothelial cells, activated monocytes / macrophages, lymphocytes, such as secretion of more M-CSF, so that M -CSF at a higher level of time, further monocyte macrophage accumulation, activation, caused by migration of VSMC proliferation, neointimal hyperplasia and subsequent RS. Determination of m-CSF serum level of risk stratification of patients and to guide further treatment. The present study revealed rapamycin in addition to the added value of anti-smooth muscle cells, the anti-inflammatory effects may be. However, AMI patients on rapamycin-eluting stents for patients before and after emergency PCI in particular inflammatory cytokines M-CSF levels in rare literature reports both at home and abroad.Objectives: To observe the effect of bare metal stent and drug-eluting stent on levels of M-CSF preoperative and postnperative and short-term outcome in patients with AMI treated by primary PCI, to discuss the feasibility of the bare stent。Methods: 1. Groups: A total of 48 patients with AMI treated with successful primary PCI within 12 hours after onset of symptoms, admitted in cardiovascular medical department , the first hospital of Jilin university, between November 2008and January 2009, with complete data, Were randomly divided into the bare metal stent group, drug-eluting stent group. 2. Sample collection: All patients were drawed blood for 3 ml from ulnar vein preoperative and 24 hour, 48 hour postoperative and put into test tube (no decoagulant). Those samples were centrifuged 10 minutes by 3000r/min immediately. Then we take upper stratum blood serum and put it in test tube. Collected samples were preserved in icebox with -80℃waiting for measured together. 3. Measure of blood serumM-CSF: Using the method of enzyme-linked immunosorbent assay (ELISA) measure levels of blood serum M-CSF preoperative and 24 hour, 48hour postoperative. 4. Statistics analysis: Measurement data are expressed as means±SD ( x±S). Analysis of measurement data use analysis of variance (ANOVA) or rank-sum test. Analysis of numeration data useχ2test, all statistical analysis were done using SPSS11. 5. Pvalue<0.05 was considered statistically significant.Results: 1. The general clinical setting: There were no difference among two groups in general state of health, exemple for age, sex, blood fat, creatine kinase, Leukocyte, smoking history, hypertensive history. Two groups of patients during hospitalization no difference in the incidence of arrhythmia .2. The interventional data: similarly there was no difference in constituent ratio of multivessel and Vascular opening time (P>0.05). 3. The level of M-CSF (ng/L): (1) two sets of pre-operative level of M-CSF was no significant difference (P> 0.05). (2) two levels of M-CSF compared with the preoperative patients were significantly increased; (3) Group 1 after 48h and after 24 hours no significant difference (P> 0.05); (4) 2 group after 48hM -CSF levels drop after 24h significantly (P <0.05); Conclusions: 1. The levels of M-CSF after primary PCI in patients with AMI were higher than that preoperative, which may be concerned with Inflammatory reaction intensified by PCI. 2. The levels of M-CSF sustained increases after Bare stent implantation group,however the levels of M-CSF Rapamycin-eluting stent group postoperative 48 hour decreased significantly compared with postoperative 24 hour and compared with Bare stent implantation group the levels of M-CSF was decreased obviously in the same time point. 3,PCI postoperative inflammatory factor M-CSF serum level associated with the RS ,Anti-inflammatory effect of eluting stents may reduce restenosis after stenting of another mechanism.4,In stent selection should be based on the specific circumstances of patients to make appropriate choices.
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