Endothelial progenitor cells predict long-term prognosis in patients with stable angina treated with percutaneous coronary intervention: five-year follow-up of the PROCREATION study

Circ J. 2013;77(7):1728-35. doi: 10.1253/circj.cj-12-1608. Epub 2013 Apr 11.


Background: The association between endothelial progenitor cells (EPCs) at the time of percutaneous coronary intervention (PCI) and the subsequent long-term clinical outcome remains undefined. To address this issue, a pre-specified analysis of the PROgenitor Cells role in Restenosis and progression of coronary ATherosclerosis after percutaneous coronary intervention (PROCREATION) study was done.

Methods and results: A total of 155 patients with stable angina treated with PCI had flow cytometry before PCI. Patients had a 5-year follow-up. Primary outcome was the composite of major adverse cardiac or cerebrovascular events (MACCE), that is, death, stroke, myocardial infarction, and revascularization. During follow-up, MACCE occurred in 65 of 155 patients (42%). There were no significant differences in clinical and angiographic variables between patients with or without MACCE, apart from a different extent of coronary atherosclerosis. The incidence of MACCE increased significantly over tertiles of CD34+/KDR+/CD45- cells and CD133+/KDR+/CD45- cells, with rates of 25%, 39%, and 69% (P=0.0001), and 26%, 44%, and 59% (P=0.003), respectively. On multivariate analysis it was estimated that the increase in CD34+/KDR+/CD45- cells was associated with a 35% higher risk for MACCE (hazard ratio [HR], 1.75; 95% confidence interval [CI]: 1.07-1.99; P=0.001), and the increase in CD133+/KDR+/CD45- cells was associated with a 25% higher risk for MACCE (HR, 1.35; 95% CI: 1.01-1.74; P=0.03).

Conclusions: Assessment of subpopulations of circulating EPCs in patients with stable angina treated with PCI can improve characterization of long-term prognosis (ClinicalTrials.gov: NCT01575431).

Publication types

  • Clinical Trial
  • Multicenter Study

MeSH terms

  • Aged
  • Angina, Stable* / blood
  • Angina, Stable* / mortality
  • Angina, Stable* / therapy
  • Antigens, Differentiation / blood*
  • Disease-Free Survival
  • Endothelial Cells / metabolism*
  • Female
  • Flow Cytometry / methods
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention / adverse effects*
  • Postoperative Complications* / blood
  • Postoperative Complications* / mortality
  • Predictive Value of Tests
  • Risk Factors
  • Stem Cells / metabolism*
  • Survival Rate
  • Time Factors


  • Antigens, Differentiation

Associated data

  • ClinicalTrials.gov/NCT01575431