Prior Cytomegalovirus Infection and the Risk of Restenosis After Percutaneous Transluminal Coronary Balloon Angioplasty

Manegold, Christoph; Alwazzeh, Marwan J; Jablonowski, H; Adams, Ortwin; Medve, Martin; Seidlitz, Beate; Heidland, Ulrich E.; Häussinger, Dieter; Strauer, B. E.; Heintzen, Matthias P.

doi:10.1161/01.cir.99.10.1290

Cited by 33 publications

(30 citation statements)

References 16 publications

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“…9 In the study on restenosis after directional atherectomy, the lower boundary of the 95% confidence interval for the odds ratio of restenosis rate in seropositive patients to that in seronegative patients was 1.91. 1 We therefore designed the study to detect an odds ratio of 1.8 at a level of significance of ␣Ͻ0.05 and a power of ␤ϭ80%, which for the given assumptions corresponds to a restenosis rate of 23% in seronegatives and of 36% in seropositives.…”

Section: Discussionmentioning

confidence: 96%

“…14 We obtained blood samples after successful stent placement and stored plasma aliquots at Ϫ70°C for later determination of CMV IgG-titers by ELISA (Enzygnost, Dade Behring). 9,15 Titers Ͻ1/230 were considered negative; lower dilutions of samples increase the likelihood of false-positives. 15 According to the manufacturer, the sensitivity and specificity of the test system are 99.3% and 98.2%, respectively.…”

Section: Patient Selection and Study Protocolmentioning

confidence: 99%

“…As in previous studies, 1,9 we therefore had to rely on antibodies titers to detect previous CMV infection. Although a more direct assay of vascular infection might have been desirable scientifically, from a clinical perspective only a relation between titers and restenosis would by relevant to decision-making.…”

Section: Limitations Of the Studymentioning

confidence: 99%

“…4 -8 The concept that CMV seropositivity carries an increased risk of restenosis has recently been challenged. Manegold et al 9 reported almost identical restenosis rates after plain balloon angioplasty in patients with and those without positive CMV titers. As a potential explanation for the discrepancy to the study by Zhou et al, 1 Manegold et al 9 proposed that the contribution of smooth muscle cell proliferation to restenosis may be larger after directional atherectomy than after balloon angioplasty alone.…”

mentioning

confidence: 95%

“…Manegold et al 9 reported almost identical restenosis rates after plain balloon angioplasty in patients with and those without positive CMV titers. As a potential explanation for the discrepancy to the study by Zhou et al, 1 Manegold et al 9 proposed that the contribution of smooth muscle cell proliferation to restenosis may be larger after directional atherectomy than after balloon angioplasty alone. This concept is supported by recent histological documentation of increased neointimal smooth muscle cell proliferation in restenotic tissue after directional atherectomy in comparison with restenotic tissue after balloon angioplasty.…”

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confidence: 95%

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Previous Cytomegalovirus Infection and Restenosis After Coronary Stent Placement

et al. 2001

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Background-Reactivated cytomegalovirus may promote neointima formation after percutaneous coronary interventions by facilitating cell cycle progression through inhibition of the eukariotic tumor suppressor protein p53. This prospective study sought to investigate the effect of previous cytomegalovirus infection on restenosis after coronary stenting. Methods and Results-In 551 consecutive patients with successful stent placement, we determined cytomegalovirus IgG titers. Primary and secondary end points were the rate of angiographic restenosis at 6 months and the rate of target vessel reintervention at 1 year, respectively. Three hundred forty patients (62%) had a positive cytomegalovirus IgG titer. We obtained angiographic follow-up in 82% of all patients. Angiographic restenosis rate was 28.7% in patients with positive cytomegalovirus titers and 34.6% in patients with negative titers (Pϭ0.18). Between the groups with and without positive cytomegalovirus titers, there were no significant differences in late lumen loss (

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Section: Discussionmentioning

confidence: 96%

Section: Patient Selection and Study Protocolmentioning

confidence: 99%

Section: Limitations Of the Studymentioning

confidence: 99%

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confidence: 95%

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confidence: 95%

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Previous Cytomegalovirus Infection and Restenosis After Coronary Stent Placement

et al. 2001

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Serological examination of human herpesvirus 6 and 7 in patients with coronary artery Disease

Ihira

Yoshikawa

Ishii

et al. 2002

Journal of Medical Virology

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Fifty-three (96%) of 55 patients with coronary artery stenosis were positive for serum anti-HHV-6 IgG, and 50 (91%) of these patients had anti-HHV-7 IgG. The number of cases sero-positive for HHV-6 and -7 in the 54 age matched control volunteers was 52 (96%) and 53 (98%), respectively. No statistical difference in the sero-prevalence of the viruses existed between the patients and the control group. The mean geometric titer (log10) of anti-HHV-6 IgG in both the patients and controls were the same (1.4) (P = 0.845), whereas anti-HHV-7 titers were 1.4 and 1.5, respectively (P = 0.161). Ten (18%) of the 55 patients had anti-HHV-6 IgM; eight (15%) of the 54 control volunteers were also positive (P = 0.636). Three (5%) of the 55 patients had anti-HHV-7 IgM, whereas 3 (6%) of the 54 control volunteers had detectable serum antibody (P = 0.691). Forty-seven of the 55 patients were examined by follow-up angiographic evaluation to clarify the association between viral infection and restenosis following balloon angioplasty. Fifteen of these patients developed restenosis, as determined by angiography. The mean geometric titer (log10) of anti-HHV-6 IgG were 1.3 and 1.4 in patients with restenosis and those without restenosis, respectively (P = 0.724). The mean geometric titer (log10) of anti-HHV-7 IgG in patients with restenosis was not significantly higher (1.5) than in patients without restenosis (1.3) (P = 0.099). Three (20%) of the 15 patients affected by restenosis had anti-HHV-6 IgM; five (16%) of the 32 control patients also had the antibody (P = 0.965). One (7%) of the 15 patients with restenosis and 2 (6%) of the 32 patients without restenosis had anti-HHV-7 IgM (P = 0.558). The present study demonstrates that HHV-6 and -7 reactivation is not associated with the establishment of coronary artery stenosis and restenosis following balloon angioplasty.

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Cytomegalovirus and Herpes Simplex Virus in Cardiovascular Disease

2003

Infections and the Cardiovascular System: New Perspectives

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Prior Cytomegalovirus Infection and the Risk of Restenosis After Percutaneous Transluminal Coronary Balloon Angioplasty

Abstract: Our data indicate that prior CMV infection, in contrast to optimal atherectomy, is not associated with chronic restenosis after conventional coronary balloon angioplasty. The results do not support a possible benefit from antiviral therapy.

Cited by 33 publications

References 16 publications

Previous Cytomegalovirus Infection and Restenosis After Coronary Stent Placement

Previous Cytomegalovirus Infection and Restenosis After Coronary Stent Placement

Serological examination of human herpesvirus 6 and 7 in patients with coronary artery Disease

Cytomegalovirus and Herpes Simplex Virus in Cardiovascular Disease

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