Berlin Buch, Franz-Volhard Klinik Berlin, Germany.
Circ Cardiovasc Interv. 2009 Feb;2(1):14-9. doi: 10.1161/CIRCINTERVENTIONS.108.795799. Epub 2008 Dec 15.
Vitronectin is a multifunctional protein with a multiple binding domain that interacts with a variety of plasma and cell proteins. Vitronectin binds multiple ligands, including the soluble vitronectin receptor. Abciximab binds equally well to soluble vitronectin receptor and glycoprotein IIb/IIIa, because both share the beta(3) subunit. We tested whether vitronectin concentrations correlate with adverse outcomes in acute coronary syndrome patients.
Baseline serum samples (n=233) from a randomized, placebo-controlled trial of abciximab plus stenting (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting EPISTENT) were retrospectively analyzed. We stratified vitronectin concentrations into the 3 lower quartiles (n=178; <49.7 microg/mL) versus the fourth upper quartile (n=55; >or=49.7 microg/mL). The end point was a major adverse cardiovascular event defined as death, myocardial infarction or urgent revascularization at 30 days and 6 months. A higher proportion of patients with baseline vitronectin >or=49.7 microg/mL had major adverse cardiovascular event than patients with baseline vitronectin <49.7 microg/mL at 30 days (18.2% versus 5.6%; P=0.01) and 6 months (20.0% versus 6.2%; P=0.006). When baseline variables not predictive of major adverse cardiovascular event (eg, troponin positive, history of congestive heart failure, diabetes, history of hypertension, smoking status) were excluded from the multivariate model, only baseline vitronectin >or=49.7 microg/mL (at 30 days: OR, 3.23; 95% CI, 1.23, 8.49; at 6 months: OR, 3.36; 95% CI, 1.33, 8.52) and history of myocardial infarction (at 30 days: OR, 5.02; 95% CI, 1.41, 17.9; at 6 months: OR, 3.99; 95% CI, 1.28, 12.43) remained. No interaction occurred between abciximab and vitronectin.
Our findings indicate that vitronectin may be an independent predictor of adverse cardiovascular outcomes following acute stenting.
纤连蛋白是一种多功能蛋白，具有多个结合域，可与多种血浆和细胞蛋白相互作用。纤连蛋白结合多种配体，包括可溶性纤连蛋白受体。阿昔单抗与可溶性纤连蛋白受体和糖蛋白 IIb/IIIa 结合能力同样强，因为两者都共享β(3)亚基。我们检测了急性冠状动脉综合征患者的纤连蛋白浓度是否与不良结局相关。
对接受阿昔单抗加支架置入术的随机、安慰剂对照试验（血小板 IIb/IIIa 抑制剂用于支架置入术的评价 EPIC 试验）的基线血清样本（n=233）进行了回顾性分析。我们将纤连蛋白浓度分为较低的 3 个四分位数（n=178；<49.7μg/ml）与较高的第 4 个四分位数（n=55；≥49.7μg/ml）。终点是主要不良心血管事件，定义为 30 天和 6 个月时的死亡、心肌梗死或紧急血运重建。基线时纤连蛋白≥49.7μg/ml 的患者发生主要不良心血管事件的比例高于基线时纤连蛋白<49.7μg/ml 的患者（30 天时为 18.2%比 5.6%；P=0.01）和 6 个月时（20.0%比 6.2%；P=0.006）。当将不能预测主要不良心血管事件的基线变量（例如肌钙蛋白阳性、充血性心力衰竭史、糖尿病、高血压史、吸烟状况）从多变量模型中排除后，仅基线时纤连蛋白≥49.7μg/ml（30 天时：OR，3.23；95%CI，1.23，8.49；6 个月时：OR，3.36；95%CI，1.33，8.52）和心肌梗死史（30 天时：OR，5.02；95%CI，1.41，17.9；6 个月时：OR，3.99；95%CI，1.28，12.43）仍有意义。阿昔单抗与纤连蛋白之间无相互作用。
我们的发现表明，纤连蛋白可能是急性支架置入术后不良心血管结局的独立预测因子。
