Von Willebrand factor (VWF) level was associated with long-term major adverse cardiovascular events in patients with acute coronary syndromes (ACS) who underwent coronary stenting, according to the results of a study published in Thrombosis Research.
The investigators studied the impact of VWF, its cleaving protease ADAMTS13, and the VWF/ADAMTS13 ratio on long-term major adverse cardiovascular outcomes (MACE) in patients who underwent percutaneous coronary intervention (PCI) between 2003 and 2006 at the Wilhelminen Hospital in Vienna, Austria.
The primary endpoint was a composite of MACE including all-cause mortality, non-fatal myocardial infarction, and non-fatal ischemic stroke during 8 years of follow-up. The secondary endpoint was all-cause mortality. VWF and ADAMTS13 antigen levels were measured prior to PCI.
The study included 701 patients undergoing PCI: 347 (49.5%) with ACS and 354 (50.5%) with stable coronary artery disease (SCAD). The mean age was 63.8 years, and the majority of the patients were men (496 patients; 70.8%). The mean follow-up duration was 6.7 years (IQR, 6.3-8.0 years).
During long-term follow up, 228 (32.5%) patients experienced MACE, including 161 (23.0%) patients who died. Among patients with ACS, VWF level was associated with MACE (adjusted hazard ratio [aHR], 1.402; 95% CI, 1.003-1.959; P =.048); however, ADAMTS13 antigen level and the VWF/ADAMTS13 ratio were not. None of the variables (VWF, ADAMTS13, or VWF/ADAMTS13) were correlated with MACE in patients with SCAD.
VWF level was associated with all-cause mortality in patients with ACS (aHR, 1.841; 95% CI, 1.187- 2.856; P =.006) but not in patients with SCAD (aHR, 1.394; 95% CI, 0.856-2.269; P =.181). Neither ADAMTS13 antigen level or the VWF/ADAMTS13 ratio were associated with all-cause mortality in patients with ACS or SCAD.
A major limitation of the study was its limited generalizability because it was conducted at a single center. The authors also noted that changes made after PCI may have impacted the study, such as the initiation of antiplatelet therapy; additionally, all patients were treated with dual antiplatelet therapy including aspirin and clopidogrel.
“VWF was associated with long-term major adverse cardiovascular events in patients with acute coronary syndromes undergoing coronary stenting, but not in stable coronary artery disease,” wrote the authors. “Neither ADAMTS13 levels nor the VWF/ADAMTS13 ratio exhibited a significant impact on long-term cardiovascular outcomes in patients undergoing coronary stenting.”
Tscharre M, Tentzeris I, Vogel B, et al. Von Willebrand Factor and ADAMTS13 and long-term outcomes in patients undergoing percutaneous coronary intervention. Thromb Res. 2020;196:31-37. doi:10.1016/j.thromres.2020.08.018