Short communicationEndothelial progenitor cells predict long-term outcome in patients with coronary artery disease: Ten-year follow-up of the PROCREATION extended study
Introduction
Endothelial progenitor cells (EPCs) are bone marrow-derived cells that play a key role in maintaining homeostasis of the endothelium [1]. In the last decade, several studies have been carried out to assess the predictive role of circulating EPCs in patients with coronary artery disease (CAD) [2,3]. Overall, these previous investigations have correlated subpopulations of EPCs with the short-term outcome of patients with CAD, but have not ascertained if EPCs are related also to long-term events. To address this issue, we performed a pre-specified subanalysis of the PROCREATION (PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention) study, a prospective investigation in a large population of patients with CAD [5]. In the main study, we found that EPCs were associated with the occurrence of restenosis or progression of coronary atherosclerosis [5]. We subsequently showed that subtypes of EPCs improved the characterization of 10-year prognosis [6]. In the present study, we performed a pre-specified analysis of the PROCREATION study in order to assess if levels of EPCs relate to the 10-year prognosis.
Section snippets
Patient population
Consecutive patients with stable angina and angiographically assessed CAD who underwent percutaneous coronary intervention were considered for this substudy. The detailed study protocol was described in the main publication [5]. The study protocol complies with the Declaration of Helsinki, and was approved by our Institutional Review Board. Written informed consent was obtained from all participating patients. The PROCREATION study is registered at ClinicalTrials.gov (Identifier: NCT01575431).
Blood samples and flow cytometry
Follow-up
Of the 155 patients included in the original study, follow-up information up to 10 years were obtained in 149 cases (96%). MACCEs occurred in 79 patients (53%). As regards the predefined composite endpoints, all-cause death occurred in 20 patients, stroke in 3 patients, myocardial infarction in 9 patients, and repeat revascularization in 47 patients, i.e. 40 percutaneous coronary intervention and 8 coronary artery by-pass grafting.
Baseline clinical, angiographic, and procedural characteristics
Patients with or without MACCE during follow-up did not show any
Discussion
Our findings demonstrate that the long-term outcome of stable angina patients with angiographically assessed CAD is associated with the baseline finding of increased levels of circulating EPCs, as we found higher levels of circulating CD34+/KDR+/CD45- cells and CD133+/KDR+/CD45- cells at referral in those patients who experienced an adverse event over the 10-year follow-up time frame.
Multiple studies have assessed the prognostic significance of EPCs in patients with CAD so far. These
Declaration of Competing Interest
The authors report no conflict of interest.
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