Endothelial Progenitor Cells in Coronary Atherosclerosis and Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis

The role of endothelial progenitor cells (EPCs) in atherosclerosis progression and neointimal growth after percutaneous coronary intervention (PCI) remains controversial. The purpose of this study was to perform a systematic review and meta-analysis of studies on EPCs in patients who had PCI. We searched Pubmed, Embase and Cochrane databases and reviewed cited references up to August 31, 2021. Overall, we selected 9 studies, including 4612 patients. Lower baseline EPC count was associated with a significantly greater occurrence of in-stent restenosis (HR 1.33; 95% CI 0.97–1.82, P = 0.045). As for EPC coating, there was no significant difference in the 1-year occurrence of cardiac death between EPCs-capturing drug-eluting stents (DES) and standard DES (Relative Risk [RR] 1.146; 95% CI 0.666–1.974, P = 0.98), but target lesion revascularization (RR 1.727; 95% CI: 1.199–2.487, P = 0.025), and target vessel failure (RR 1.591; 95% CI 1.213–2.088, P = 0.04) were significantly more common with EPCs-capturing DES than with standard DES. Circulating EPC count might improve risk stratification after PCI, as it is correlated with the occurrence of in-stent restenosis. Currently available EPCs-capturing DES use was associated with an increased risk of 1-year adverse events, mainly driven by an increase in target lesion revascularization and target vessel failure, not cardiac death. • Our meta-analysis highlights that EPCs have the ability to predict the occurrence of in-stent restenosis after PCI. • EPC-capturing DES use is associated with an increased risk of 1-year adverse events, not cardiac death. • EPCs seem have a major role in the pathophysiology of stent healing.