title: Prognostic role of multiple biomarkers in stable patients undergoing fractional flow reserve-guided coronary angioplasty.
abstract: OBJECTIVE
  Fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI), along with optimal medical therapy, improves clinical outcome by targeting ischemia-inducing stenosis. Yet, plaque progression or stent failure may cause recurring cardiac events. We assessed the potential prognostic role of different inflammatory biomarkers, known to be associated with plaque progression or stent failure, in patients undergoing FFR-guided PCI.
  
  
  METHODS
  We prospectively enrolled 169 stable angina patients with intermediate coronary stenosis at angiography undergoing FFR-guided PCI. PCI was performed if FFR was 0.80 or less, deferred if FFR was more than 0.80. Serum baseline levels of high-sensitivity C-reactive protein (hs-CRP), eosinophil cationic protein (ECP), cystatin-C (Cys-C), and thromboxane A2 (TXA2) were assessed. Rate of major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, recurrent myocardial infarction, and target vessel revascularization (TVR), was evaluated.
  
  
  RESULTS
  PCI was performed in 78 patients (46%) (mean age 69 ± 10 years, men 73%) and deferred in 91 patients (54%) (mean age 64 ± 11 years, men 53%). Mean clinical follow-up was 31 ± 11 months. Within the PCI group, patients with MACE (n = 14 [18%]) had significantly higher ECP levels than those without (14.4 [9.3-19.5] vs. 4.9 [2.8-10.9] mg/l, P < 0.001), and ECP was a significant predictor of MACE (hazard ratio: 1.05, 95% confidence interval [1.01-1.09], P = 0.021). Within the deferred group, patients with MACE (n = 8 [9%]) had significantly higher CRP levels than those without (15 [6.5-31.9] vs. 1.6 [0.9-2.9] mg/l, P < 0.001) and CRP was a significant predictor of MACE (hazard ratio: 1.04, 95% confidence interval [1.01-1.07], P = 0.015). Cys-C and TXA2 were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Assessing inflammatory biomarkers allows the identification of patients remaining at residual higher risk of MACE after FFR-guided PCI.
authors.affiliation: aInstitute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy bCardiovascular Center Aalst, OLV Hospital, Aalst, Belgium cDepartment of Advanced Biomedical Sciences, Federico II University, Naples dInterventional Cardiology, Sant'Eugenio Hospital, Rome eDepartment of Cardiology, IRCCS Policlinico San Donato, Milan, Italy *Giampaolo Niccoli and Emanuele Barbato contributed equally to the writing of this article.
authors.forename: Francesco
authors.initials: F
authors.lastname: Fracassi
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.forename: Micaela
authors.initials: M
authors.lastname: Conte
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Sgueglia
authors.forename: Bernard
authors.initials: B
authors.lastname: De Bruyne
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Montone
authors.forename: William
authors.initials: W
authors.lastname: Wijns
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Emanuele
authors.initials: E
authors.lastname: Barbato
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D055316:Cystatin C / Q000097:blood; D018450:Disease Progression; D047150:Eosinophil Cationic Protein / Q000097:blood; D005260:Female; D053805:Fractional Flow Reserve, Myocardial / Q000502:physiology*; D006801:Humans; D018836:Inflammation Mediators / Q000032:analysis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D015607:Stents; D013928:Thromboxane A2 / Q000097:blood
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D018836:Inflammation Mediators; D013928:Thromboxane A2; D002097:C-Reactive Protein; D047150:Eosinophil Cationic Protein; C479220:RNASE3 protein, human