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Endothelial Progenitor Cells in Coronary Atherosclerosis and Percutaneous Coronary Intervention: A Systematic Review
Francesco Pelliccia1, Vincenzo Pasceri2, Marco Zimarino3
1Department of Cardiovascular Sciences, Sapienza University, Rome, Italy.
Insights
Lower endothelial progenitor cell (EPC) counts predict in-stent restenosis after percutaneous coronary intervention (PCI). EPC-capturing drug-eluting stents (DES) did not increase cardiac death but raised risks for target lesion revascularization and target vessel failure.
Area of Science:
- Cardiovascular Medicine
- Regenerative Medicine
- Interventional Cardiology
Background:
- Endothelial progenitor cells (EPCs) play a complex role in atherosclerosis and post-PCI neointimal growth.
- Existing research on EPCs in PCI patients presents conflicting findings.
Purpose of the Study:
- To systematically review and meta-analyze existing studies on EPCs in patients undergoing PCI.
- To clarify the association between EPCs and outcomes after PCI.
Main Methods:
- Systematic search of PubMed, Embase, and Cochrane databases up to August 31, 2021.
- Inclusion of 9 studies comprising 4612 patients.
- Meta-analysis of data on baseline EPC counts and EPC-capturing stent outcomes.
Main Results:
- A lower baseline EPC count was significantly associated with increased in-stent restenosis (HR 1.33, P=0.045).
- EPC-capturing drug-eluting stents (DES) showed no significant difference in 1-year cardiac death compared to standard DES (RR 1.146, P=0.98).
- However, EPC-capturing DES were linked to significantly higher rates of target lesion revascularization (RR 1.727, P=0.025) and target vessel failure (RR 1.591, P=0.04).
Conclusions:
- Circulating EPC counts may aid in risk stratification post-PCI due to their correlation with in-stent restenosis.
- Current EPC-capturing DES are associated with increased 1-year adverse events, primarily target lesion revascularization and target vessel failure, not cardiac death.
Introduction:
The role of endothelial progenitor cells (EPCs) in atherosclerosis progression and neointimal growth after percutaneous coronary intervention (PCI) remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of studies on EPCs in patients who had PCI.
Methods:
We searched Pubmed, Embase and Cochrane databases and reviewed cited references up to August 31, 2021. Overall, we selected 9 studies, including 4612 patients.
Results:
Lower baseline EPC count was associated with a significantly greater occurrence of in-stent restenosis (HR 1.33; 95% CI 0.97-1.82, P = 0.045). As for EPC coating, there was no significant difference in the 1-year occurrence of cardiac death between EPCs-capturing drug-eluting stents (DES) and standard DES (Relative Risk [RR] 1.146; 95% CI 0.666-1.974, P = 0.98), but target lesion revascularization (RR 1.727; 95% CI: 1.199-2.487, P = 0.025), and target vessel failure (RR 1.591; 95% CI 1.213-2.088, P = 0.04) were significantly more common with EPCs-capturing DES than with standard DES.
Conclusion:
Circulating EPC count might improve risk stratification after PCI, as it is correlated with the occurrence of in-stent restenosis. Currently available EPCs-capturing DES use was associated with an increased risk of 1-year adverse events, mainly driven by an increase in target lesion revascularization and target vessel failure, not cardiac death.
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