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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:e121.)
© 2006 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Elevated Plasma Active Matrix Metalloproteinase-9 Level Is Associated With Coronary Artery In-Stent Restenosis

Gregory T. Jones; I. Patrick Kay; J.W. S. Chu; G.T. Wilkins; L.V. Phillips; M. McCormick; A.M. van Rij; M.J.A. Williams

From the Sections of Surgery (G.T.J., L.V.P., A.M.v.) and Medicine (I.P.K., J.W.S.C., G.T.W., M.M., M.J.A.W.), University of Otago, Dunedin, New Zealand.

Correspondence to Dr Gregory T. Jones, Vascular Research Group, Section of Surgery, University of Otago, PO Box 913, Dunedin, New Zealand. E-mail greg.jones{at}otago.ac.nz

Objective— This study aimed to determine whether the plasma levels of matrix metalloproteinase-9 (MMP-9) or tissue inhibitor of metalloproteinases-1 (TIMP-1) were altered in patients with a history of symptomatic in-stent restenosis (ISR).

Methods and Results— A group of 158 patients with a history of ISR were compared with 128 symptom-free patients. Plasma samples and a detailed risk factor history were collected. Plasma samples were analyzed for pro–MMP-9 and latent MMP-9 and active MMP-9, latent MMP-3, and TIMP-1. Several variables were associated with ISR, including index coronary disease extent and severity (number of diseased vessels and American College of Cardiology/American Heart Association lesion classification), number, diameter, and total length of stent(s) inserted, and plasma high-density lipoprotein cholesterol. Plasma active MMP-9 (odds ratio, 1.96; 95% CI, 1.43 to 2.69) showed independent risk association with ISR. Patients with multiple sites of ISR had significantly higher levels of active MMP-9 compared with patients with only a single ISR lesion or no ISR.

Conclusion— Plasma active MMP-9 levels may be a useful independent predictor of bare metal stent ISR.

This study aimed to determine whether plasma MMP-9 or TIMP-1 levels were elevated in patients with a history of (bare metal) in-stent restenosis. Plasma active MMP-9 was independently associated with ISR with a stratified risk association with the number of sites of ISR. Future studies should therefore prospectively evaluate plasma levels of active MMP-9 as a possible independent predictor of ISR.

Key Words: plasma • MMP-9 • TIMP-1 • restenosis

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