Abstract 2829: Increased Soluble Vitronectin Receptor Levels Predict Risk in Patients Undergoing Coronary Stenting
Introduction: Acute coronary syndromes (ACS) are characterized by increased platelet activation/aggregation. The vitronectin receptor (VNR), which promotes the binding of endothelial cells to platelets, is found in serum in a soluble form (sVNR). Abciximab reduces cardiac ischemic events associated with percutaneous coronary intervention (PCI) and binds equally well to VNR and GP IIb/IIIa, as both share the β3 subunit.
Objective: To determine if elevated sVNR correlates with adverse cardiovascular outcomes post-PCI, and if abciximab alters outcomes in patients with high sVNR levels.
Methods: Assays were performed on baseline serum samples (n=233) from patients with similar interventions from the placebo-controlled, randomized trial of abciximab plus stenting (EPISTENT). Based on sVNR level, data were stratified into the lower 3 quartiles (n=178; < 49.7 ng/ml) vs the 4th quartile (n=55; ≥ 49.7 ng/ml). The primary endpoint was the occurrence of MACE (death, MI or urgent revascularization) at 30 days and 6 months.
Results: Univariate analysis demonstrated that patients with high sVNR (median 58.4 ng/ml, range: 49.9 –101.8 ng/ml) were significantly more likely to have a MACE event compared with low sVNR (median 34.8 ng/ml, range: 7.5– 49.6 ng/ml) at 30 days (18.2% vs 5.6%, p<0.05) and 6 months (20.0% vs 6.2%, p<0.01). A multivariate logistic regression model demonstrated that high sVNR significantly correlated with an increased risk of MACE (OR 3.94, 95% CI 1.37–11.33) at 30 days while treatment with abciximab tended to reduce it (OR 0.37, 95% CI 0.11–1.23) when other univariate predictors (MI history, troponin positive, congestive heart failure, diabetes, hypertension, and smoking status) were forced into the model. There was no treatment interaction with sVNR levels. If other predictors were allowed to drop out of the model, only sVNR (OR 3.23, 95%CI 1.23– 8.49) and history of MI (5.02, 95% CI 1.41–17.9) remained. High sVNR levels were similarly predictive of events through 6 months (OR 3.36, 95%CI 1.33– 8.52).
Conclusions: sVNR is an independent predictor of adverse cardiovascular outcomes after PCI. Treatment with abciximab tended to reduce events independent of sVNR level although larger, prospective studies would be required for confirmation.