Abstract 17849: Serum Vascular Endothelial Growth Factor Levels Associated With the Risk of Major Adverse Cardiac and Cerebrovascular Events After Drug-eluting Stent Implantation

Abstract

Background: Vascular endothelial growth factor (VEGF), a central player in angiogenesis, is not only involved in the progression of atherosclerotic plaque, but also required for preventing decompensated heart failure (HF). High circulating oxidatively modified LDL-cholesterol (oxLDL) levels are associated with vulnerability to the rupture of atherosclerotic lesions. However, the relationships of circulating VEGF and oxLDLs with major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing coronary drug-eluting stent (DES) implantation are unclear. Methods and Results: We enrolled 441 patients who electively underwent coronary DES implantation. Patients were followed up over 2 years. MACCE were defined as cardiac and cerebrovascular death, acute coronary syndrome, stroke, and HF hospitalization. Revascularization for asymptomatic patients were excluded. Pre-procedural serum levels of high-sensitivity CRP (hsCRP), VEGF, and two oxLDLs, serum-amyloid-A/LDL complex (SAA-LDL) and α1-antitrypsin/LDL complex (AT-LDL), were measured. During a median follow-up of 720 (IQR, 498-720) days, MACCE developed in a total of 39 patients (8.8%). Patients were divided into two groups based on the median of each biomarker. In Kaplan-Meier analyses, high-VEGF and high-SAA-LDL ( P =0.009, P =0.0498 by log-rank test, respectively), but not high-hsCRP or high-AT-LDL, were significantly associated with MACCE. Multivariate Cox proportional hazard analyses revealed that natural log-transformed VEGF levels (Ln-VEGF) (HR, 1.9 per 1 SD increase; 95% CI, 1.3 to 3.0; P =0.001), but not Ln-SAA-LDL (HR, 1.2; 95% CI, 0.89-1.5, P =0.3), Ln-hsCRP, or Ln-AT-LDL, was significantly associated with MACCE after adjustment for age, sex, and established risk factors. Finally, we performed stepwise multivariate Cox proportional hazard analysis including possible confounders, such as the number of lesions and type of DES, and these biomarkers. Notably, the independent predictors of MACCE were age (HR, 1.8 per 10 years; 95% CI, 1.2-2.7; P =0.004), Ln-VEGF (HR, 1.9; 95% CI, 1.2-3.1; P =0.005) and chronic kidney disease (HR, 2.5; 95% CI, 1.2-5.0; P =0.01). Conclusions: A high VEGF value may serve as a predictor of MACCE following coronary DES implantation.