Author + information
- Received June 15, 2009
- Revision received September 17, 2009
- Accepted October 29, 2009
- Published online January 1, 2010.
- Katharina M. Katsaros, MD⁎,
- Stefan P. Kastl, MD⁎,
- Gerlinde Zorn, BSci⁎,
- Gerald Maurer, MD⁎,
- Johann Wojta, PhD⁎,
- Kurt Huber, MD†,⁎ (, )
- Günter Christ, MD⁎ and
- Walter S. Speidl, MD⁎
- ↵⁎Reprint requests and correspondence:
Dr. Kurt Huber, Director, Third Medical Department, Cardiology and Emergency Medicine, Wilhelminen Hospital, Montleartstrasse 37, A-1160 Vienna, Austria
Objectives Our aim was to test whether serum levels of matrix metalloproteinase (MMP)-2 and -9 are associated with the development of in-stent restenosis (ISR) after implantation of drug-eluting stents (DES).
Background With the introduction of DES coronary ISR could be reduced dramatically. However, it still plays a significant role, particularly after treatment of multiple, complex lesions.
Methods We studied 85 patients who were treated with 159 DES. Blood samples for measurement of MMP-2 and -9 antigen and activity were taken directly before and 24 h after percutaneous coronary intervention (PCI). Restenosis was evaluated at 6 to 8 months by coronary angiography.
Results During the follow-up period, 2 patients (2.4%) died of cardiovascular causes, and 12 patients developed angiographic ISR. Patients with ISR showed significantly higher serum activity of MMP-9 at baseline (p = 0.017) and of MMP-2 (p < 0.0001) and MMP-9 (p < 0.0001) after the procedure. The PCI increased serum activity of MMP-2 (p = 0.005) and MMP-9 (p = 0.008) only in patients with ISR. The restenosis rates of patients in the highest quartile of MMP-2 after and MMP-9 before and after PCI were 40.0%, 38.9%, and 42.9% compared with 6.3%, 7.7%, and 4.0% in the lower quartiles, respectively. This was independent of clinical and procedural characteristics.
Conclusions Elevated serum activities of MMP-2 and -9 are associated with dramatically increased restenosis rates after PCI with implantation of DES. Determination of MMP levels might be useful for identification of patients who are at high risk for ISR despite implantation of DES.
This work was supported by the Ludwig Boltzmann Foundation for Cardiovascular Research and by the Association for the Promotion of Research in Arteriosclerosis, Thrombosis, and Vascular Biology.
- Received June 15, 2009.
- Revision received September 17, 2009.
- Accepted October 29, 2009.
- American College of Cardiology Foundation