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European Heart Journal Advance Access published online on April 21, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp120
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Pre-intervention eosinophil cationic protein serum levels predict clinical outcomes following implantation of drug-eluting stents

Giampaolo Niccoli1,*, Domenico Schiavino2, Flavia Belloni1, Giuseppe Ferrante1, Giuseppe La Torre3, Micaela Conte1, Nicola Cosentino1, Rocco Antonio Montone1, Vito Sabato2, Francesco Burzotta1, Carlo Trani1, Antonio Maria Leone1, Italo Porto1, Maurizio Pieroni1, Giampiero Patriarca2 and Filippo Crea1

1 Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
2 Department of Internal Medicine and Allergology, Catholic University of the Sacred Heart, Rome, Italy
3 Institute of Biostatistic and Epidemiology, Catholic University of the Sacred Heart, Rome, Italy

Received 25 March 2008; revised 25 February 2009; accepted 10 March 2009 * Corresponding author. Tel: +39 06 30154187, Fax: +39 06 3055535, E-mail: gniccoli73{at}hotmail.it

Aims: Eosinophils have been identified in post-mortem studies as important players of both restenosis and thrombosis after drug-eluting stent (DES) implantation. We aimed at assessing the association between baseline levels of eosinophil cationic protein (ECP), a marker of eosinophil activation, and recurrence of clinical events in a consecutive series of patients who underwent DES implantation.

Methods and results: Two hundred patients (age 63 ± 10.4, males 75%) undergoing implantation of first-generation DES (Taxus or Cypher stents) were enrolled. We measured serum levels of ECP and total IgE by enzyme-linked immunosorbent assay and of C-reactive protein by high-sensitivity nephelometry prior to percutaneous coronary intervention. A clinical follow-up was planned 18 months after discharge. Major adverse cardiac events (MACEs), such as cardiac death, recurrent myocardial infarction, or clinically driven target lesion revascularization, were the endpoint of the study. Twenty-two patients (11%) had MACEs and showed higher serum levels of ECP compared with those without MACEs [30.5 (14.4–50) vs. 12.2 (4.4–31) µg/L, P = 0.004]. At simple Cox regression analysis, serum levels of ECP were a significant predictor of MACEs (hazard ratio 1.016, 95% confidence interval 1.003–1.03, P = 0.018).

Conclusion: This study shows for the first time an association between baseline ECP levels and the occurrence of MACEs in patients undergoing implantation of DES. Further studies are warranted to establish whether in this setting ECP is a risk marker or plays a contributory pathogenetic role.

Key Words: Drug-eluting stent • Eosinophils • Eosinophil cationic protein • Prognosis


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