CLINICAL STUDY: CARDIAC CATHETERIZATION
The impact of plasma levels of C-reactive protein, lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting
The global evaluation of new events and restenosis after stent implantation study
Michael N. Zairis, MD*,*,
John A. Ambrose, MD, FACC ,
Stavros J. Manousakis, MD*,
Alexander S. Stefanidis, MD*,
Olga A. Papadaki, MD*,
Helen I. Bilianou, MD*,
Mary C. DeVoe, RN,
Constantine N. Fakiolas, MD*,
Evangelos G. Pissimissis, MD*,
Christopher D. Olympios, MD*,
Stefanos G. Foussas, MD, FESC, FACC* GENERATION Study Group
* Department of Cardiology, Tzanio Hospital, Piraeus, Greece
Department of Medicine, The Comprehensive Cardiovascular Center, Saint Vincent Catholic Medical Centers, New York, New York, USA
Manuscript received December 4, 2001;
revised manuscript received May 30, 2002,
accepted July 2, 2002.
* Reprint requests and correspondence: Dr. Michael N. Zairis, 273-277 Alkiviadou Street, Piraeus, 18536, Greece.
zairis{at}hellasnet.gr
OBJECTIVES: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS)
BACKGROUND: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited.
METHODS: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion ( 50% luminal diameter stenosis) that was located in a nonintervened vessel at restudy, resulting in an angiographically significant lesion ( 70% luminal diameter stenosis).
RESULTS: By the end of the follow-up, high plasma levels of either CRP or Lp(a) but not tHCY were independently associated with the primary end point. In particular, CRP 0.68 mg/dl (p < 0.001) or Lp(a) 25 mg/dl (p = 0.003) conferred a significantly increased risk. By 1 year, a CRP 0.68 mg/dl conferred a significantly increased risk for clinical recurrence of symptoms (p < 0.001) or PTSL (p < 0.001). None of the studied biochemical markers was related to ISR.
CONCLUSIONS: High plasma levels of either CRP or Lp(a) but not tHCY may be associated with a higher incidence of late adverse events after successful CS. PTSL in vessels not previously intervened upon may play a significant role in the underlying pathophysiology as opposed to ISR.
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Abbreviations and Acronyms
| | CLR | | clinical recurrence of symptoms | | CRP | | C-reactive protein | | CS | | coronary stenting | | GENERATION | | Global Evaluation of New Events and Restenosis After Stent Implantation | | ISR | | in-stent restenosis | | Lp(a) | | lipoprotein (a) | | NSTACS | | non–ST-segment elevation acute coronary syndrome | | PCI | | percutaneous coronary intervention | | PTSL | | progression to a significant lesion | | ROC | | receiver operating characteristics | | STEMI | | ST-segment elevation myocardial infarction | | tHCY | | total homocysteine |
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