Abstract 14787: Inverse Association of Vascular Endothelial Growth Factor-C With the Risk of Restenosis and Cardiovascular Events After Drug-Eluting Stent Implantation
Background: Vascular endothelial growth factor-C (VEGF-C) plays a central role in lymphangiogenesis. Recently, we demonstrated that VEGF-C is closely associated with dyslipidemia and atherosclerosis. However, the relationship of VEGF-C levels with the risk of restenosis and cardiovascular events following drug-eluting stent (DES) implantation is unknown.
Methods and Results: We enrolled 294 consecutive patients (393 lesions) who underwent successful DES implantation and had an 8-month follow-up angiogram. Pre-procedural serum levels of high-sensitivity C-reactive protein (hsCRP), VEGF-A, and VEGF-C were measured. At the 8-month follow-up, intra-stent restenosis (ISR) developed in a total of 21 lesions (5.3%). Stepwise logistic regression analysis, including established risk factors, hsCRP, VEGF-A, and VEGF-C levels, revealed that diabetes (OR, 3.2; 95% CI, 1.2-10; P = 0.03), smoking (OR, 5.3; 95% CI, 1.4-34; P = 0.03), VEGF-A (OR, 2.1; 95% CI, 1.1-4.7; P = 0.04) and VEGF-C levels (OR, 0.45; 95% CI, 0.21 0.91; P = 0.03) were independent determinants of ISR. Receiver operating characteristic curve (ROC) analyses for ISR revealed that the area under the curve (AUC) of established risk factors was 0.740. The addition of VEGF-A and VEGF-C levels further increased the AUC (0.765). Then, we examined the predictive value of VEGF-C for major adverse cardiovascular events (MACE). Patients were followed up over 30 months. The median follow-up was 420 (IQR: 302-599) days. During the follow-up period, MACE developed in a total of 55 patients (18.7%). Patients were divided into two groups based on the optimal cut-off value of each biomarker determined by ROC analyses. In Kaplan-Meier analyses, low-VEGF-C, but not high-hsCRP or high VEGF-A, was significantly associated with MACE (P = 0.03, P = 0.08, and P = 0.08 by log-rank test, respectively). Stepwise Cox proportional hazard analysis, including established risk factors, high-hsCRP, high-VEGF-A, low-VEGF-C, and the type of DES, revealed that low-VEGF-C (HR, 2.1; 95% CI, 1.2 to 3.7; P = 0.013) and high-VEGF-A (HR, 1.8; 95% CI, 1.1 to 3.2; P = 0.03), but not high-hsCRP, were independently associated with MACE.
Conclusions: A low VEGF-C value may serve as a predictor of ISR and MACE following DES implantation.
- © 2013 by American Heart Association, Inc.