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Relationship between biomarkers and subsequent clinical and angiographic restenosis after paclitaxel-eluting stents for treatment of STEMI: a HORIZONS-AMI substudy

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Abstract

Drug-eluting stents (DES) reduce the incidence of in-stent restenosis (ISR) after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Whether the use of biomarkers might be of utility to identify patients who remain at risk for DES ISR after primary PCI has never been examined. A total of 26 biomarkers were measured at enrollment and 30 days and analyzed at a central core laboratory in 501 STEMI patients from the HORIZONS-AMI trial. All patients underwent primary PCI with the TAXUS paclitaxel-eluting stent (PES), were scheduled for routine angiographic follow-up at 13 months, and were followed for 3 years. Mean in-stent late-loss was 0.28 ± 0.57 mm, and target lesion revascularization (TLR) at 3 years occurred in 9.1 % of patients. Low levels of interleukin-6 (IL-6) and placental growth factor (PLGF) at admission were associated with both higher in-stent late loss and ischemia-driven TLR. Additionally, low admission levels of cardiotrophin-1 (CT-1) were associated with higher rates of ischemia-driven TLR. At 30-day follow-up lower values of IL-1ra (IL-1ra), matrix metalloproteinase 9 (MMP9), and myeloperoxidase (MPO), and a decline relative to admission in IL-1ra, monocyte chemotactic protein-1 (MCP-1), and MMP9 were associated with higher in-stent late loss. Low values of IL-6 at 30 days were also associated with ischemia-driven TLR. After multivariate adjustment, only MPO at 30 days and a decline of MCP-1 between admission and 30 days were associated with in-stent late loss, and only CT-1 was associated with TLR. MPO at 30 days and a decline of MCP-1 between admission and 30 days were independently associated with in-stent late loss, and CT-1 was associated with TLR. Additional studies to confirm and validate the utility of these biomarkers are warranted.

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Conflict of interest

The HORIZONS-AMI trial was supported by the Cardiovascular Research Foundation, with grant support from Boston Scientific and the Medicines Company. Dr. Dangas and has received speaker honoraria from Astra Zeneca, Bristol-Meiers Squibb, The Medicines Co, Sanofi Aventis, and Abbott Vascular. Dr Mehran has received a research grant from Sanofi Aventis, and honoraria from The Medicines Company, Abbott Vascular, Sanofi Aventis, Bristol Meiers Squibb, Cordis, and Astra Zeneca. Dr. Witzenbichler has received lecture honoraria from Boston Scientific and The Medicines Company. Dr. Guagliumi has served as a consultant Boston Scientific and Volcano, and has received lecture honoraria from Boston Scientific, Medtronic, Lightlab, Labcoat, and receiving grant support from Medtronic and Boston Scientific. Dr Brodie is in the Speakers Bureau of the Medicines Co. Dr. Stone is on the scientific advisory boards for and has received honoraria from Abbott Vascular and Boston Scientific, and has served as a consultant to the Medicines Company, Eli Lilly BMS/Sanofi and AstraZeneca. The other authors report no conflicts.

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Authors and Affiliations

  1. Cardiovascular Research Foundation, New York, NY, USA

    Bimmer E. Claessen, Gregg W. Stone, Roxana Mehran, Elias A. Sanidas, Vasiliki Chantziara, Diaa Hakim, Selene Leon, Ke Xu & George D. Dangas

  2. Columbia University Medical Center, New York, NY, USA

    Gregg W. Stone, Elias A. Sanidas, Vasiliki Chantziara & Diaa Hakim

  3. Mount Sinai Medical Center, New York, NY, USA

    Roxana Mehran & George D. Dangas

  4. Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Bimmer E. Claessen, José PS Henriques & Jan GP Tijssen

  5. Ospedali Reuniti di Bergamo, Bergamo, Italy

    Giulio Guagliumi

  6. Charité Universitatsmedizin Campus Benjamin Franklin, Berlin, Germany

    Bernhard Witzenbichler

  7. University of Ulm, Ulm, Germany

    Jochen Wöhrle

  8. LeBauer CV Research Foundation, Greensboro, NC, USA

    Bruce R. Brodie

  9. National Institute of Cardiology, Warsaw, Poland

    Adam Witkowski

  10. Szpital Jana Pawla II, Krakow, Poland (KZ)

    Bimmer E. Claessen, Gregg W. Stone, Roxana Mehran, Krzysztof Zmudka, Elias A. Sanidas, Vasiliki Chantziara, Diaa Hakim, Selene Leon, Ke Xu & George D. Dangas

  11. Cardiovascular Institute, Mount Sinai Medical Center, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA

    Bimmer E. Claessen, Gregg W. Stone, Roxana Mehran, Elias A. Sanidas, Vasiliki Chantziara, Diaa Hakim, Selene Leon, Ke Xu, George D. Dangas & George D. Dangas

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  1. Bimmer E. Claessen
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  2. Gregg W. Stone
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  4. Bernhard Witzenbichler
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  5. Bruce R. Brodie
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  6. Jochen Wöhrle
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  7. Adam Witkowski
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  8. Giulio Guagliumi
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  9. Krzysztof Zmudka
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  10. José PS Henriques
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  11. Jan GP Tijssen
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  12. Elias A. Sanidas
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  13. Vasiliki Chantziara
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  14. Diaa Hakim
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  15. Selene Leon
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  16. Ke Xu
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  17. George D. Dangas
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Corresponding author

Correspondence to George D. Dangas.

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Claessen, B.E., Stone, G.W., Mehran, R. et al. Relationship between biomarkers and subsequent clinical and angiographic restenosis after paclitaxel-eluting stents for treatment of STEMI: a HORIZONS-AMI substudy. J Thromb Thrombolysis 34, 165–179 (2012). https://doi.org/10.1007/s11239-012-0706-x

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  • DOI: https://doi.org/10.1007/s11239-012-0706-x

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