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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation

^a Department of Internal Medicine IV, Division of Cardiology, University of Frankfurt, Frankfurt, Germany

Manuscript received February 9, 2000; revised manuscript received September 29, 2000, accepted November 3, 2000.

Reprint requests and correspondence: Dr. Dirk H. Walter, Department of Internal Medicine IV, Division of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
D.Walter{at}em.uni-frankfurt.de

OBJECTIVES

This study assessed the predictive value of preprocedural C-reactive protein (CRP) levels on six-month clinical and angiographic outcome in patients undergoing coronary stent implantation.

BACKGROUND

Recent data indicate that low-grade inflammation as detected by elevated CRP serum levels predicts the risk of recurrent coronary events.

METHODS

We prospectively investigated the predictive value of preprocedural CRP-levels on restenosis and six-month clinical outcome in 276 patients after coronary stent implantation. The primary combined end point was death due to cardiac causes, myocardial infarction related to the target vessel and repeat intervention of the stented vessel.

RESULTS

Grouping patients into tertiles according to preprocedural CRP-levels revealed that, despite identical angiographic and clinical characteristics at baseline and after stent implantation, a primary end point event occurred in 24 (26%) patients of the lowest tertile, in 42 (45.6%) of the middle tertile and in 38 (41.3%) of the highest CRP tertile, p = 0.01. On multivariate analysis, tertiles of CRP levels were independently associated with a higher risk of adverse coronary events (relative risk = 2.0 [1.1 to 3.5], tertile I vs. II and III, p = 0.01) in addition to the minimal lumen diameter after stent (p = 0.04). In addition, restenosis rates were significantly higher in the two upper tertiles compared with CRP levels in the lowest tertile (45.5% vs. 38.3% vs. 18.5%, respectively, p = 0.002).

CONCLUSIONS

Low-grade inflammation as evidenced by elevated preprocedural serum CRP-levels is an independent predictor of adverse outcome after coronary stent implantation, suggesting that a systemically detectable inflammatory activity is associated with proliferative responses within successfully implanted stents.

Abbreviations and Acronyms   CRP = C-reactive protein   MI = myocardial infarction   MLD = minimal luminal diameter   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk   TVR = target vessel revascularization

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