Plasma
Level of Hepatocyte Growth Factor (HGF) after Percutaneous Coronary
Intervention (PCI) Is a Useful Predictor of Restenosis
Jun
Tateishi,
Hyogo College of Medicine, Nishinomiya, Japan
Hepatocyte
growth factor (HGF) is a potent endothelium-specific growth
factor with mitogenic activity that has been shown to reach
elevated levels in plasma following endothelial injury. In this
study, the rise in plasma HGF levels, which peaked 12 hours
after percutaneous coronary intervention (PCI, was shown to
correlate with development of restenosis at 6-month follow-up.
Hepatocyte growth factor (HGF) is a potent endothelium-specific
growth factor with marked mitogenic activity. Plasma levels
of HGF have been shown to rise in response to various endothelial
stresses, including hypertension-induced endothelial damage.
When coronary artery restenosis occurs, it is caused in part
by a shift in the balance between growth inhibition and promotion
toward the promotion of growth of vascular smooth muscle cells
(VSMC). Because percutaneous coronary intervention (PCI) creates
acute endothelial injury and one of the main factors contributing
to restenosis is a growth factor-mediated increase in VSMC growth,
it was hypothesized that an increase in HGF following PCI may
contribute to restenosis.
Study design
had two goals: to determine whether HGF plasma levels rise
after PCI, and, if this occurs, whether the rise in HGF level
is associated with post-procedural restenosis. Because HGF
levels are known to rise following administration of heparin,
study patients received argatroban, a thrombin inhibitor,
rather than heparin in conjunction with their PCI procedures.
Of 55 consecutive patients undergoing PCI for coronary artery
occlusion, 9 received heparin and 46 received argatroban.
The results demonstrated that the steep rise in HGF levels
immediately following heparin administration (40-fold compared
with baseline level) did not occur following argatroban administration.
The 46 patients who received argatroban as an anticoagulant
were evaluated 6 months after their PCI procedures. Within
that group, 17% of patients had angiographic evidence of restenosis.
There was a significant correlation between the elevation
in plasma HGF levels 12 hours following PCI and the presence
of restenosis 6 months later. Conclusion: An increment in
plasma HGF of >0.3 ng/mL at 12 hours after PCI (when performed
with argatroban rather than heparin) compared with the baseline
HGF level may predict the development of restenosis [p = 0.04;
odds ratio = 3.93 (95% CI = 14.2 - 1.09)].
Reporter:
Andre Weinberger, MD
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