Balance between angiogenic and anti-angiogenic isoforms of VEGF-A is associated with the complexity and severity of coronary artery disease

Introduction Assessing the complexity of coronary artery disease (CAD) is clinically important. Vascular endothelial growth factor A (VEGF-A) is a powerful and the most important regulator of angiogenesis. It has been reported that the anti-angiogenic isoform of VEGF-A (VEGF-A₁₆₅b) inhibits angiogenesis. The purpose of this study was to evaluate the relationship between the complexities of CAD using the Syntax score (SS) and the levels of circulating total VEGF-A or VEGF-A₁₆₅b. Methods A total of 268 patients who underwent percutaneous coronary intervention (PCI) were enrolled. Of these, 73 patients without acute coronary syndrome or previous revascularization were included in this study. These subjects were divided into two groups according to the SS. Circulating total VEGF-A and VEGF-A₁₆₅b levels were measured using an enzyme-linked immunosorbent assay. Results Circulating levels of total VEGF-A were significantly higher in the SS > 22 (high SS) group than in the SS ≤ 22 (low SS) group (p = 0.018). Moreover, the ratio of VEGF-A₁₆₅b to total VEGF-A was significantly lower for the high SS group (p = 0.004). The levels of total VEGF-A independently predicted high SS after adjusting for other significant variables among patients who underwent PCI (odds ratio, 1.004; 95% CI, 1.001 to 1.006; p = 0.01). Conclusions These data indicated that high SS was associated with circulating levels of total VEGF-A and the ratio of VEGF-A₁₆₅b to total VEGF-A in patients with complex CAD.