Endothelial Progenitor Cells Predict Cardiovascular Events after Atherothrombotic Stroke and Acute Myocardial
Elisa Cuadrado-Godia1, Ander Regueiro2, Julio Núñez3
1Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Insights
Low levels of endothelial progenitor cells (EPC) and high carotid intima-media thickness (IMT) predict new vascular events after myocardial infarction or stroke. Circulating endothelial cells (CEC) did not show prognostic value.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Biomarkers
Background:
- Acute myocardial infarction (AMI) and atherothrombotic stroke (AS) pose significant risks for subsequent vascular events.
- Identifying reliable prognostic factors is crucial for early intervention and risk stratification.
- Endothelial progenitor cells (EPC) and circulating endothelial cells (CEC) are potential biomarkers of vascular health.
Purpose of the Study:
- To determine prognostic factors for new vascular events within 6 months post-AMI or AS.
- To investigate the predictive role of EPC and CEC in patients experiencing acute cardiovascular events.
Main Methods:
- Prospective study of 150 patients (100 AMI, 50 AS) excluding those with prior coronary artery disease or ischemic strokes.
- Flow cytometry analysis of EPC and CEC counts at baseline.
- Follow-up for 6 months to assess new vascular events (NVE), defined by recurrent events or cardiovascular hospitalizations/death.
- Multivariate Cox regression analysis incorporating vascular risk factors, carotid intima-media thickness (IMT), and cell counts.
Main Results:
- 19 patients (12.66%) experienced a new vascular event during follow-up.
- Univariate analysis identified age, IMT ≥ 0.9 mm, and EPC count as associated with NVE.
- Multivariate analysis revealed independent associations between the lowest quartile of EPC (HR: 10.33) and IMT ≥ 0.9 mm (HR: 4.12) with increased risk of future vascular events.
Conclusions:
- Basal EPC levels and elevated carotid IMT (≥ 0.9 mm) are significant predictors of future vascular events in patients with AMI and AS.
- CEC count did not demonstrate a significant association with cardiovascular risk in this cohort.
- These findings highlight the prognostic utility of EPC and IMT in risk stratification for secondary vascular events.
Introduction:
The aim of this study was to determine prognostic factors for the risk of new vascular events during the first 6 months after acute myocardial infarction (AMI) or atherothrombotic stroke (AS). We were interested in the prognostic role of endothelial progenitor cells (EPC) and circulating endothelial cells (CEC).
Methods:
Between February 2009 and July 2012, 100 AMI and 50 AS patients were consecutively studied in three Spanish centres. Patients with previously documented coronary artery disease or ischemic strokes were excluded. Samples were collected within 24h of onset of symptoms. EPC and CEC were studied using flow cytometry and categorized by quartiles. Patients were followed for up to 6 months. NVE was defined as new acute coronary syndrome, transient ischemic attack (TIA), stroke, or any hospitalization or death from cardiovascular causes. The variables included in the analysis included: vascular risk factors, carotid intima-media thickness (IMT), atherosclerotic burden and basal EPC and CEC count. Multivariate survival analysis was performed using Cox regression analysis.
Results:
During follow-up, 19 patients (12.66%) had a new vascular event (5 strokes; 3 TIAs; 4 AMI; 6 hospitalizations; 1 death). Vascular events were associated with age (P = 0.039), carotid IMT≥0.9 (P = 0.044), and EPC count (P = 0.041) in the univariate analysis. Multivariate Cox regression analysis showed an independent association with EPC in the lowest quartile (HR: 10.33, 95%CI (1.22-87.34), P = 0.032] and IMT≥0.9 [HR: 4.12, 95%CI (1.21-13.95), P = 0.023].
Conclusions:
Basal EPC and IMT≥0.9 can predict future vascular events in patients with AMI and AS, but CEC count does not affect cardiovascular risk.
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