Abstract 9462: Endothelial Progenitor Cells Predict Five-Year Prognosis In Patients With Stable Angina Treated With Percutaneous Coronary Intervention

Abstract

Background. Endothelial progenitor cells (EPCs) have a pathogenetic role in stent restenosis after percutaneous coronary intervention (PCI). It remains undefined, however, if an association between numbers of EPCs at time of PCI and the subsequent long-term clinical outcome exists. To address this issue, we performed a pre-specified analysis of follow-up data of the PROCREATION (PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention) study. Methods. A total of 155 patients (92 men, age 60±11 years) with stable angina treated with PCI were originally included in the PROCREATION study. All patients had flow cytometry the day before elective PCI in order to derive subpopulations of EPCs. After the index PCI, patients underwent 1-year control angiography and were then evaluated at 6-month intervals up to 5 years. The occurrence of major adverse cardiac events (MACE) was recorded in all patients. Results. During the 5-year follow-up, all-cause death occurred in 16 patients (10%), cardiovascular death in 9 (6%), non fatal myocardial infarction in 6 (4%), and target vessel revascularization in 41 (26%). There were no significant differences in clinical and angiographic variables between patients with or without MACE. After adjusting for age, sex, left ventricular function, and number of diseased vessels, it was found that halving of numbers of CD34+/KDR+/CD45- cells and CD133+/KDR+/CD45- cells (i.e., progenitors of endothelial lineage) increased the risk of MACE by 75% (hazard ratio: 1.75; 95% confidence intervals: 1.1 to 2.8) and 66% (hazard ratio: 1.32; 95% confidence intervals: 0.9 to 2.3), respectively. Conversely, there were no relationships between outcome and numbers of CD14+/CD45+ cells (i.e., which play a role in angiogenesis via a paracrine effect) and CD105+/CD45-/CD34- cells (i.e., which have a receptor for transforming growth factor-beta). Conclusions. Patients with stable angina treated with PCI who have a worse clinical outcome have lower numbers of circulating EPCs subtypes that are progenitors of endothelial lineage at time of the procedure. Assessment of EPCs at PCI can improve characterization of long-term prognosis. (ClinicalTrials.gov Identifier: NCT01575431 )