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Original Articles

Vitronectin Concentrations Predict Risk in Patients Undergoing Coronary Stenting

Wolfgang Derer, MD; Elliot S. Barnathan, MD; Erdal Safak, MD; Prasheen Agarwal, PhD; Harald Heidecke, PhD; Martin Möckel, MD; Michael Gross, MD; Cemil Oezcelik, MD; Rainer Dietz, MD and Ralf Dechend, MD

From the HELIOS Klinikum Charité, Campus Virchow, Berlin, (E.S., M.M., C.O., R.D.), and Berlin Buch, Franz-Volhard Klinik Berlin, (W.D., M.G., R.D.), Germany, Centocor Research and Development, Inc. (E.S.B., P.A.), Malvern, Pa; and CellTrend (H.H.), Luckenwalde, Germany.

Correspondence to Dr. Ralf Dechend, HELIOS Klinikum, Schwanebecker Chaussee 50 13125, Berlin, Germany. E-mail ralf.dechend{at}charite.de

Received May 30, 2008; accepted December 12, 2008.

Background— Vitronectin is a multifunctional protein with a multiple binding domain that interacts with a variety of plasma and cell proteins. Vitronectin binds multiple ligands, including the soluble vitronectin receptor. Abciximab binds equally well to soluble vitronectin receptor and glycoprotein IIb/IIIa, because both share the β₃ subunit. We tested whether vitronectin concentrations correlate with adverse outcomes in acute coronary syndrome patients.

Methods and Results— Baseline serum samples (n=233) from a randomized, placebo-controlled trial of abciximab plus stenting (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting EPISTENT) were retrospectively analyzed. We stratified vitronectin concentrations into the 3 lower quartiles (n=178; <49.7 µg/mL) versus the fourth upper quartile (n=55; 49.7 µg/mL). The end point was a major adverse cardiovascular event defined as death, myocardial infarction or urgent revascularization at 30 days and 6 months. A higher proportion of patients with baseline vitronectin 49.7 µg/mL had major adverse cardiovascular event than patients with baseline vitronectin <49.7 µg/mL at 30 days (18.2% versus 5.6%; P=0.01) and 6 months (20.0% versus 6.2%; P=0.006). When baseline variables not predictive of major adverse cardiovascular event (eg, troponin positive, history of congestive heart failure, diabetes, history of hypertension, smoking status) were excluded from the multivariate model, only baseline vitronectin 49.7 µg/mL (at 30 days: OR, 3.23; 95% CI, 1.23, 8.49; at 6 months: OR, 3.36; 95% CI, 1.33, 8.52) and history of myocardial infarction (at 30 days: OR, 5.02; 95% CI, 1.41, 17.9; at 6 months: OR, 3.99; 95% CI, 1.28, 12.43) remained. No interaction occurred between abciximab and vitronectin.

Conclusions— Our findings indicate that vitronectin may be an independent predictor of adverse cardiovascular outcomes following acute stenting.

Key Words: risk factors • vitronectin • stents • glycoproteins IIb-IIIa

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