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CLINICAL STUDIES

Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty

^a Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy
^* A.Fa.R., Ospedale Fetebenefratelli-Isola Tiberina, Rome, Italy

Manuscript received October 1, 1998; revised manuscript received March 25, 1999, accepted June 28, 1999.

Reprint requests and correspondence: Dr. Antonino Buffon, Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Largo Gemelli, 8 - 00168 Rome, Italy.
abuffon{at}mail.OMNITEL.IT

OBJECTIVES

We sought to investigate whether early and late outcome after percutaneous transluminal coronary angioplasty (PTCA) could be predicted by baseline levels of acute-phase reactants.

BACKGROUND

Although some risk factors for acute complications and restenosis have been identified, an accurate preprocedural risk stratification of patients undergoing PTCA is still lacking.

METHODS

Levels of C-reactive protein (CRP), serum amyloid A protein (SAA) and fibrinogen were measured in 52 stable angina and 69 unstable angina patients undergoing single vessel PTCA.

RESULTS

Tertiles of CRP levels (relative risk [RR] = 12.2, p < 0.001), systemic hypertension (RR = 4.3, p = 0.046) and female gender (RR = 4.1, p = 0.033) were the only independent predictors of early adverse events. Intraprocedural and in-hospital complications were observed in 22% of 69 patients with high serum levels (>0.3 mg/dl) of CRP and in none of 52 patients with normal CRP levels (p < 0.001). Tertiles of CRP levels (RR = 6.2, p = 0.001), SAA levels (RR = 6.0, p = 0.011), residual stenosis (RR = 3.2, p = 0.007) and acute gain (RR = 0.3, p = 0.01) were the only independent predictors of clinical restenosis. At one-year follow-up, clinical restenosis developed in 63% of patients with high CRP levels and in 27% of those with normal CRP levels (p < 0.001).

CONCLUSIONS

Preprocedural CRP level, an easily measurable marker of acute phase response, is a powerful predictor of both early and late outcome in patients undergoing single vessel PTCA, suggesting that early complications and clinical restenosis are markedly influenced by the preprocedural degree of inflammatory cell activation.

Abbreviations and Acronyms   CABG = coronary bypass graft surgery   CI = confidence interval   CRP = C-reactive protein   ECG = electrocardiogram   MI = myocardial infarction   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk   SAA = serum amyloid A protein   TIMI = Thrombolysis in Myocardial Infarction

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