Circulating of Endothelial Progenitor Cells Correlate with Neointima Formation After Implantation of EPC-Capture Stents and BMS in Acute Coronary Syndromes.
1Medical University of Silesia,, Katowice, Poland; 2American Heart of Poland, Ustron, Poland
W. Wojakowski1, A. Pyrlik1, M. Krol2, P. Buszman1, A. Ochala1, D. Kawecki1, A. Rudnik2, G. Smolka1, K. Milewski1, A. Zurakowski2, W. Cybulski1, M. Kondys2, I. Mroz1, M. Tendera1
Background: Aim was to investigate the association between the number of circulating endothelial progenitor cells (EPCs), levels of chemoattractants and neointima formation 6 months after implantation of EPC-capture stents, EPCS (Genous, OrbusNeich) and bare metal stents (BMS) in patients with NSTE-ACS (Comparison of Efficiency of High Dose Atorvastatin and Endothelial Progenitor-Capture Stents and Bare Metal Stents in Reduction of Neointimal nary Syndromes; randomized JACK-EPC trial; NCT00494247)
Methods: 60 patients with NSTE-ACS (70% NSTEMI/30% unstable angina) were randomized for implantation of EPCS (n=30) or BMS (n=30), received 80mg atorvastatin prior to PCI followed by 80 mg /day and 600 mg loading dose of clopidogrel. Neointima formation was assessed after 6 months by QCA (in-stent late loss (LL), binary restenosis) and IVUS (neointima volume, neointima volume index). Inclusion criteria: de novo lesion >70% in native coronary artery, target vessel diameter 2.5-4.0mm, lesion length ≤30mm. Exclusion Criteria: diabetes, cardiogenic shock, bleeding, thrombocytopenia, other stenoses requiring revascularization <6months, previous revascularization, left main stenosis >50%, allergy to statins.
Results: Both groups presented mostly with type B2/C lesions (EPCS: 53/30; BMS: 50/30%). Rates of MACE were comparable in both groups, without in-stent thrombosis. Mean stent length was 20.1±8 and 19.9±10mm and mean stent diameter 3.0±0.97 and 3.1±0.88mm, respectively. In 6-months follow-up the binary restenosis rate was significantly higher in BMS group (26.6%) than in EPC-capture stent group (13%).In both groups the number of circulating EPCs at admission was significantly higher than after 6 months (admission: median 4,7 (1.2-6.9) and 4,9 (0,7-6,8), p=0.15; follow-up: 1,8 (0.2-3.1) and 1,8 (0,3-3,5), p=0.67). Number of circulating EPC measured prior to PCI was negatively correlated with neointima volume measured by IVUS (r=-0.46, p=0.03) and in-stent LL in QCA (r=-0.37, p<0.05). Patients with in-stent restenosis after 6 months had less circulating EPCs at admission (3.0 vs. 4.5, p=0.002), but comparable number of EPCs after 6 months. No differences in plasma levels of chemoattractants (VEGF, SDF-1, G-CSF, HGF) and expression of endothelial markers (VE-cadherin, von Willebrand factor, P-selectin) in isolated EPCs were found in patients with and without restenosis.
Conclusion: In patients with NSTE-ACS treated with EPCs-capture stents the early mobilization of EPC is significantly correlated with neointima formation after 6 months.
