Association between Prior Cytomegalovirus Infection and the Risk of Restenosis after Coronary Atherectomy
Neointimal hyperplasia and arterial remodeling cause restenosis in 20 to 50 percent of patients who have undergone coronary angioplasty. 1 , 2 Although the mechanisms are unknown, previous findings have raised the possibility that cytomegalovirus (CMV) contributes to the development of restenosis in...
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| Published in | The New England journal of medicine Vol. 335; no. 9; pp. 624 - 630 |
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| Main Authors | , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Boston, MA
Massachusetts Medical Society
29.08.1996
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Neointimal hyperplasia and arterial remodeling cause restenosis in 20 to 50 percent of patients who have undergone coronary angioplasty.
1
,
2
Although the mechanisms are unknown, previous findings have raised the possibility that cytomegalovirus (CMV) contributes to the development of restenosis in some patients.
3
In approximately one third of patients with restenosis, the lesions contain CMV DNA sequences. Smooth-muscle cells grown from such lesions express IE84, one of the virus's immediate early proteins, and IE84 binds to and inhibits the p53 tumor-suppressor gene product. These effects may enhance the proliferation of smooth-muscle cells or inhibit apoptosis, either of which may contribute . . . |
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| AbstractList | Neointimal hyperplasia and arterial remodeling cause restenosis in 20 to 50 percent of patients who have undergone coronary angioplasty.
1
,
2
Although the mechanisms are unknown, previous findings have raised the possibility that cytomegalovirus (CMV) contributes to the development of restenosis in some patients.
3
In approximately one third of patients with restenosis, the lesions contain CMV DNA sequences. Smooth-muscle cells grown from such lesions express IE84, one of the virus's immediate early proteins, and IE84 binds to and inhibits the p53 tumor-suppressor gene product. These effects may enhance the proliferation of smooth-muscle cells or inhibit apoptosis, either of which may contribute . . . Restenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been found that cytomegalovirus (CMV) DNA is present in restenotic lesions from atherectomy specimens. This and other evidence suggest that CMV may have a role in the process of restenosis. We prospectively studied 75 consecutive patients undergoing directional coronary atherectomy for symptomatic coronary artery disease. Before atherectomy was performed, we measured blood levels of anti-CMV IgG antibodies to determine whether previous exposure to CMV increased the risk of restenosis, as determined by coronary angiography performed six months after atherectomy. After atherectomy, the mean (+/- SD) minimal luminal diameter of the target vessel was greater in the 49 patients who were seropositive for CMV than in the 26 patients who were seronegative (3.18 +/- 0.51 mm vs. 2.89 +/- 0.45 mm, P=0.01). After six months, however, the seropositive patients had a greater reduction in the luminal diameter (1.24 +/- 0.83 mm vs. 0.68 +/- 0.69 mm, P = 0.003), resulting in a significantly higher rate o restenosis in the seropositive patients (43 percent vs. 8 percent, P = 0.002). In a multivariable logistic-regression model, CMV seropositivity and the CMV titer were independently predictive of restenosis (odds ratios, 12.9 and 8.1, respectively). There was no evidence of acute infection, since the titer of anti-CMV IgG antibodies did not increase over time and tests for anti-CMV IgM antibodies were negative in all patients. Prior infection with CMV is strong independent risk factor for restenosis after coronary atherectomy. If confirmed, these findings may help identify patients at risk for restenosis. Background Restenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been found that cytomegalovirus (CMV) DNA is present in restenotic lesions from atherectomy specimens. This and other evidence suggest that CMV may have a role in the process of restenosis. Methods We prospectively studied 75 consecutive patients undergoing directional coronary atherectomy for symptomatic coronary artery disease. Before atherectomy was performed, we measured blood levels of anti-CMV IgG antibodies to determine whether previous exposure to CMV increased the risk of restenosis, as determined by coronary angiography performed six months after atherectomy. Results After atherectomy, the mean (±SD) minimal luminal diameter of the target vessel was greater in the 49 patients who were seropositive for CMV than in the 26 patients who were seronegative (3.18±0.51 mm vs. 2.89±0.45 mm, P = 0.01). After six months, however, the seropositive patients had a greater reduction in the luminal diameter (1.24±0.83 mm vs. 0.68±0.69 mm, P = 0.003), resulting in a significantly higher rate of restenosis in the seropositive patients (43 percent vs. 8 percent, P = 0.002). In a multivariable logistic-regression model, CMV seropositivity and the CMV titer were independently predictive of restenosis (odds ratios, 12.9 and 8.1, respectively). There was no evidence of acute infection, since the titer of anti-CMV IgG antibodies did not increase over time and tests for anti-CMV IgM antibodies were negative in all patients. Conclusions Prior infection with CMV is a strong independent risk factor for restenosis after coronary atherectomy. If confirmed, these findings may help identify patients at risk for restenosis. BACKGROUNDRestenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been found that cytomegalovirus (CMV) DNA is present in restenotic lesions from atherectomy specimens. This and other evidence suggest that CMV may have a role in the process of restenosis.METHODSWe prospectively studied 75 consecutive patients undergoing directional coronary atherectomy for symptomatic coronary artery disease. Before atherectomy was performed, we measured blood levels of anti-CMV IgG antibodies to determine whether previous exposure to CMV increased the risk of restenosis, as determined by coronary angiography performed six months after atherectomy.RESULTSAfter atherectomy, the mean (+/- SD) minimal luminal diameter of the target vessel was greater in the 49 patients who were seropositive for CMV than in the 26 patients who were seronegative (3.18 +/- 0.51 mm vs. 2.89 +/- 0.45 mm, P=0.01). After six months, however, the seropositive patients had a greater reduction in the luminal diameter (1.24 +/- 0.83 mm vs. 0.68 +/- 0.69 mm, P = 0.003), resulting in a significantly higher rate o restenosis in the seropositive patients (43 percent vs. 8 percent, P = 0.002). In a multivariable logistic-regression model, CMV seropositivity and the CMV titer were independently predictive of restenosis (odds ratios, 12.9 and 8.1, respectively). There was no evidence of acute infection, since the titer of anti-CMV IgG antibodies did not increase over time and tests for anti-CMV IgM antibodies were negative in all patients.CONCLUSIONSPrior infection with CMV is strong independent risk factor for restenosis after coronary atherectomy. If confirmed, these findings may help identify patients at risk for restenosis. |
| Author | Zhou, Yi Fu Finkel, Toren Epstein, Stephen E Popma, Jeffery J Waclawiw, Myron A Leon, Martin B Yu, Zu Xi |
| Author_xml | – sequence: 1 givenname: Yi Fu surname: Zhou fullname: Zhou, Yi Fu – sequence: 2 givenname: Martin B surname: Leon fullname: Leon, Martin B – sequence: 3 givenname: Myron A surname: Waclawiw fullname: Waclawiw, Myron A – sequence: 4 givenname: Jeffery J surname: Popma fullname: Popma, Jeffery J – sequence: 5 givenname: Zu Xi surname: Yu fullname: Yu, Zu Xi – sequence: 6 givenname: Toren surname: Finkel fullname: Finkel, Toren – sequence: 7 givenname: Stephen E surname: Epstein fullname: Epstein, Stephen E |
| BackLink | http://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=3203838$$DView record in Pascal Francis https://www.ncbi.nlm.nih.gov/pubmed/8687516$$D View this record in MEDLINE/PubMed |
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| CODEN | NEJMAG |
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| References | 9036314 - N Engl J Med. 1997 Feb 20;336(8):587-8; author reply 588 9036313 - N Engl J Med. 1997 Feb 20;336(8):587; author reply 588 Geist LJ (r012) 1991; 5 Foley DP (r018) 1994; 90 r020 r001 r023 van Dam-Mieras MCE (r026) 1992; 68 Zhou YF (r029) 1995; 92 Grundy JE (r022) 1993; 78 Klacsmann P (r006) 1977; 49 Melnick JL (r004) 1993; 14 r019 r013 r014 r015 r016 Pryzdial ELG (r028) 1994; 84 Zhu H (r030) 1995; 69 r031 r010 r011 Kowalik TF (r021) 1993; 78 r007 r008 r002 Jordan MC (r005) 1973; 79 Jacobson MA (r009) 1988; 108 r024 r003 r025 Stein B (r017) 1995; 91 r027 |
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| Snippet | Neointimal hyperplasia and arterial remodeling cause restenosis in 20 to 50 percent of patients who have undergone coronary angioplasty.
1
,
2
Although the... Restenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been found that... Background Restenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been... BACKGROUNDRestenosis occurs commonly after coronary angioplasty and atherectomy, but the causes of restenosis are poorly understood. Recently, it has been... |
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| SubjectTerms | Adult Aged Angioplasty Antibodies, Viral - blood Apoptosis Atherectomy, Coronary Biological and medical sciences Cell cycle Cineangiography Coronary Artery Disease - diagnostic imaging Coronary Artery Disease - surgery Coronary Artery Disease - virology Coronary Disease - diagnostic imaging Coronary Disease - surgery Coronary Disease - virology Cytomegalovirus Cytomegalovirus - immunology Cytomegalovirus Infections - complications Cytomegalovirus Infections - immunology Female Gene expression Hepatitis Antibodies - blood Hepatovirus - immunology Humans Immunoglobulin G - blood Linear Models Logistic Models Male Medical sciences Middle Aged Multivariate Analysis Patients Prospective Studies Recurrence Risk Factors Serologic Tests Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart |
| Title | Association between Prior Cytomegalovirus Infection and the Risk of Restenosis after Coronary Atherectomy |
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