Circulating endothelial progenitor cells are inversely correlated with in-stent restenosis in patients with non-ST-segment elevation acute coronary syndromes treated with EPC-capture stents (JACK-EPC trial)

Aim. Aim of the study was to evaluate the association between circulating endothelial progenitor cells (EPCs) and angiographic outcomes after implantation of GenousTM stent in patients with non-ST-segment elevation acute coronary syndromes (ACS) (NSTEACS) undergoing urgent percutaneous coronary intervention (PCD. Methods. Sixty patients treated with EPC-capture stent (N.=30) or bare metal stents (BMS) (N.=30) receiving 80 mg atorvastatin and dual antiplatelet therapy (DAT) for 12 months. Restenosis was assessed after 6 months by quantitative coronary angiography (QCA) and major acute coronary events (MACE) evaluated after 6 and 12 months. Inclusion criteria: de novo lesion >70% in native vessel, diameter 2.5-4 nun, lesion length <30 mm. Exclusion criteria: diabetes, previous revascularization, significant left main stenosis, chronic total occlusions (CTO) and multivessel disease. Results. Majority of patients in EPC-capture stent and BMS groups presented with NSTEMI (73.3% and 70%, respectively). Mean stent length was 20.1 +/- 8 and 19.9 +/- 10 mm, diameter 3-10.97 and 3.1 +/- 0.88 mm in respective groups. The binary restenosis was significantly lower in Genous (TM) (13 vs. 26.6%, P=0.04). Risk of MACE after 6 and 12 months were comparable in both groups. There was no stent thrombosis. Numbers of circulating EPCs were significantly approximately 2-fold higher during the ACS than after 6 months. Mobilization of EPCs during acute ischemia was significantly lower in patients who developed restenosis after 6 months (3 vs. 4.5 cells/mu L, P=0.002) and it was negatively correlated with late-loss after 6 months (R=-0.42; P<0.03). Conclusion. Use of Genous (TM) stents in NSTE-ACS is associated with lower restenosis rate than BMS at 6 months. There was no ST through 1 year. The number of circulating EPCs is inversely correlated with in-stent late loss (LL).