Previous cytomegalovirus infection and risk of coronary thrombotic events after stent placement

Background-Cytomegalovirus (CMV) infection induces upregulation of tissue f actor and loss of anticoagulants, including thrombomodulin, prostacyclin, a nd tissue plasminogen activator. CMV infection may thereby increase the pro coagulant properties of coronary artery plaques. This prospective study inv estigated the effect of previous CMV infection on the early hazard of coron ary stent placement. Methods and Results-In 551 consecutive patients with successful coronary st ent placement, we determined CMV IgG titers. The end point was the composit e rate of death, nonfatal Q-wave myocardial infarction, and urgent reinterv ention during 30-day follow-up. The study population represented the entire spectrum of coronary stenting; an acute coronary syndrome was present in 5 0% of the patients. A positive CMV IgG titer (greater than or equal to 1/23 0) was found in 340 patients (62%). Of these, 10 reached the end point duri ng 30-day follow-up (2 deaths, 4 infarctions, 4 urgent reinterventions). In the group with negative CMV titer, thrombotic events did not occur (P=0.01 4 versus group with positive CMV titers). After correction for pertinent co variables, a significant relation between positive CMV titer and the 30-day end point prevailed (P<0.001). Conclusions-Previous CMV infection may increase the risk of coronary thromb otic events after stent placement.