Endothelial Progenitor Cells Predict Cardiovascular Events after Atherothrombotic Stroke and Acute Myocardial Infarction. A PROCELL Substudy.
BACKGROUND
The aim of this study was to determine prognostic factors for the risk of new vascular events during the first 6 months after acute myocardial infarction (AMI) or atherothrombotic stroke (AS). We were interested in the prognostic role of endothelial progenitor cells (EPC) and circulating endothelial cells (CEC).


METHODS
Between February 2009 and July 2012, 100 AMI and 50 AS patients were consecutively studied in three Spanish centres. Patients with previously documented coronary artery disease or ischemic strokes were excluded. Samples were collected within 24h of onset of symptoms. EPC and CEC were studied using flow cytometry and categorized by quartiles. Patients were followed for up to 6 months. NVE was defined as new acute coronary syndrome, transient ischemic attack (TIA), stroke, or any hospitalization or death from cardiovascular causes. The variables included in the analysis included: vascular risk factors, carotid intima-media thickness (IMT), atherosclerotic burden and basal EPC and CEC count. Multivariate survival analysis was performed using Cox regression analysis.


RESULTS
During follow-up, 19 patients (12.66%) had a new vascular event (5 strokes; 3 TIAs; 4 AMI; 6 hospitalizations; 1 death). Vascular events were associated with age (P = 0.039), carotid IMT≥0.9 (P = 0.044), and EPC count (P = 0.041) in the univariate analysis. Multivariate Cox regression analysis showed an independent association with EPC in the lowest quartile (HR: 10.33, 95%CI (1.22-87.34), P = 0.032] and IMT≥0.9 [HR: 4.12, 95%CI (1.21-13.95), P = 0.023].


CONCLUSIONS
Basal EPC and IMT≥0.9 can predict future vascular events in patients with AMI and AS, but CEC count does not affect cardiovascular risk.
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Elisa
E
Cuadrado-Godia
Cardiology Department, Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Ander
A
Regueiro
Cardiology Department, Hospital Clínico Universitario, Valencia.School of Medicine.Universitat de València, Valencia, Spain.
Julio
J
Núñez
Hemotherapy-Hemostasis Department, Biomedical Diagnostics Center, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Maribel
M
Díaz-Ricard
Valencia INCLIVA Biomedical Research Institute, Hospital Clínico, Valencia; Department of Physiology, Universitat de València, València, Spain.
Susana
S
Novella
Nephrology Department, Hospital del Mar. Universitat Autònoma de Barcelona, Barcelona, Spain.
Anna
A
Oliveras
Laboratory of Molecular Physiology and Channelopathies, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
Miguel A
MA
Valverde
Epidemiology and Cardiovascular Genetics Group. IMIM, Barcelona, Spain.
Jaume
J
Marrugat
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Angel
A
Ois
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Eva
E
Giralt-Steinhauer
Cardiology Department, Hospital Clínico Universitario, Valencia.School of Medicine.Universitat de València, Valencia, Spain.
Juan
J
Sanchís
Hemotherapy-Hemostasis Department, Biomedical Diagnostics Center, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Ginès
G
Escolar
Valencia INCLIVA Biomedical Research Institute, Hospital Clínico, Valencia; Department of Physiology, Universitat de València, València, Spain.
Carlos
C
Hermenegildo
Cardiology Department, Thorax Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
Magda
M
Heras
Department of Neurology, Neurovascular Research Group, IMIM-Hospital del Mar (Institut Hospital del Mar d'Investigacions Mèdiques), Universitat Autònoma de Barcelona/DCEXS-Universitat Pompeu Fabra, Barcelona, Spain.
Jaume
J
Roquer
D000208:Acute Disease; D000368:Aged; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000473:pathology; D066026:Endothelial Progenitor Cells / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications / Q000473:pathology; D006973:Hypertension / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000473:pathology; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000473:pathology