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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Statin therapy, inflammation and recurrent coronary events in patients following coronary stent implantation

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

Manuscript received May 15, 2001; revised manuscript received August 2, 2001, accepted August 22, 2001.

^* Reprint requests and correspondence: Dr. Andreas M. Zeiher, Department of Internal Medicine IV, Division of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
Zeiher{at}em.uni-frankfurt.de

OBJECTIVES

We sought to investigate whether statin therapy affects the association between preprocedural C-reactive protein (CRP) levels and the risk for recurrent coronary events in patients undergoing coronary stent implantation.

BACKGROUND

Low-grade inflammation as detected by elevated CRP levels predicts the risk of recurrent coronary events. The effect of inflammation on coronary risk may be attenuated by statin therapy.

METHODS

We investigated a potential interrelation among statin therapy, serum evidence of inflammation, and the risk for recurrent coronary events in 388 consecutive patients undergoing coronary stent implantation. Patients were grouped according to the median CRP level (0.6 mg/dl) and to the presence of statin therapy.

RESULTS

A primary combined end point event occurred significantly more frequently in patients with elevated CRP levels without statin therapy (RR [relative risk] 2.37, 95% CI [confidence interval] [1.3 to 4.2]). Importantly, in the presence of statin therapy, the RR for recurrent events was significantly reduced in the patients with elevated CRP levels (RR 1.27 [0.7 to 2.1]) to about the same degree as in patients with CRP levels below 0.6 mg/dl and who did not receive statin therapy (RR 1.1 [0.8 to 1.3]).

CONCLUSIONS

Statin therapy significantly attenuates the increased risk for major adverse cardiac events in patients with elevated CRP levels undergoing coronary stent implantation, suggesting that statin therapy interferes with the detrimental effects of inflammation on accelerated atherosclerotic disease progression following coronary stenting.

Abbreviations and Acronyms   CI = confidence interval   CARE = Cholesterol And Recurrent Events trial   CRP = C-reactive protein   MI = myocardial infarction   MIRACL = Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering trial   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   RR = relative risk   TVR = target vessel revascularization

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