Coronary artery disease
Peripheral CD34+ Cells and the Risk of In-Stent Restenosis in Patients With Coronary Heart Disease

https://doi.org/10.1016/j.amjcard.2005.06.042Get rights and content

In-stent restenosis represents the major limitation of percutaneous coronary revascularization. The underlying neointimal hyperplasia mainly consists of smooth muscle cells (SMCs), which can be derived from bone marrow cells. We hypothesized that changes in the peripheral progenitor cell counts after coronary stenting may predict the development of restenosis. We prospectively studied men with atherosclerotic coronary artery disease who had undergone successful elective stenting of solitary target lesions (n = 17). Peripheral blood samples were drawn at baseline (before stenting) and 1 day after stenting. The CD34+ cell count was determined by flow cytometry. Follow-up quantitative coronary angiography was performed after 8.1 ± 2.6 months. Except for longer primary lesions in patients with angiographic restenosis, no significant differences in patient and lesion characteristics were seen. The rate of restenosis (75% vs 11%, p = 0.015) and the extent of diameter stenosis at follow-up (56.9 ± 26.9% vs 26.5 ± 16.5%, p = 0.012) were higher in patients with a postprocedural increase in CD34+ cells than in those with a decrease in CD34+ cells. Postprocedural CD34+ cell counts were increased in patients with restenosis but decreased in those without restenosis (p = 0.002). A robust correlation was seen between the change in CD34+ cells and late lumen loss (r = 0.65, p <0.005). In a multivariate regression model, the change in CD34+ cells, lesion length, and preprocedural minimal lumen diameter independently predicted for late lumen loss. In conclusion, an increase in circulating CD34+ cells after coronary stenting constitutes an independent risk factor predicting in-stent restenosis and may be suggestive of their involvement in neointimal hyperplasia.

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Patients, angioplasty, and stenting procedure

Men treated at the University Hospital Aachen were enrolled in a single-center prospective study. The inclusion criteria were successful elective stenting of a single de novo coronary lesion (>50% diameter stenosis) in men aged 18 to 85 years, who had been diagnosed with stable or unstable angina or silent ischemia. The exclusion criteria were an ejection fraction of <30%, unprotected left main location, heavy calcification, excessive tortuosity of the proximal vessel, use of a drug-eluting

Patient characteristics

The study population consisted of 17 men with successful elective coronary stenting, follow-up angiographic data, and none of the exclusion criteria applicable. The mean age was 66.8 years, with a high prevalence of dyslipidemia, diabetes, and hypertension (Table 1). The target vessel was the left anterior descending artery in 41.2% of the patients, right coronary artery in 11.6%, and left circumflex artery in 41.2%. Although all target lesions were primary lesions, 17.6% of the patients had

Discussion

Although a role for bone marrow–derived, circulating SMC progenitors in neointima formation after vascular injury has been demonstrated in animal models, a relation between circulating progenitor cells and in-stent restenosis in humans has not been evaluated. We found that angiographic restenosis is associated with an increase in circulating CD34+ cells 1 day after stent placement. Furthermore, we found a positive correlation between the postprocedural increase in circulating CD34+ cells and

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This study was supported by Deutsche Forschungsgemeinschaft (grants WE1913/7-1 and SCHO1056/2-1), Bonn, Germany.

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