Prognostic Impact of Preprocedural C-Reactive Protein Levels on Six-Month Angiographic and One-Year Clinical Outcomes After Drug-Eluting Stent Implantation

Duk-Woo Park ¹, Cheol Whan Lee ¹, Sung-Cheol Yun ¹, Young-Hak Kim ¹, Myeong-Ki Hong ¹, Jae-Joong Kim ¹, Seong-Wook Park ¹ and Seung-Jung Park ^1*

¹ Asan Medical Center, Korea, Republic of

^* To whom correspondence should be addressed. E-mail: sjpark{at}amc.seoul.kr.

Accepted 28 November 2006

Abstract

Objective To determine the association of preprocedural C-reactive protein (CRP) levels with angiographic restenosis and adverse clinical events after drug-eluting stents (DES) implantation.

Design Prospective cohort analysis of preprocedural CRP levels as predictor of serious ischemic complications or binary restenosis in patients treated with DES.

Setting Tertiary referral centre.

Patients 1,650 consecutive patients who underwent successful DES implantation. Patients were grouped into tertiles according to preprocedural CRP values for data analysis.

Interventions Successful DES implantation Main outcome measures: The primary end point was a major coronary event, defined as cardiac death or Q-wave myocardial infarction.

Results Baseline clinical and angiographic characteristics were similar between the tertile groups, except that more patients had multivessel disease and acute coronary syndrome with increasing tertiles of CRP levels. At 1-year follow-up, a primary end point occurred in 4 (0.7%) patients of the lowest tertile, in 3 (0.5%) of the middle tertile and in 16 (2.9%) of the highest tertile (p=0.003). In multivariate analysis, the highest tertile of CRP levels was independent predictor of a major coronary event (hazard ratios 4.68, 95% confidence interval 1.91-11.44, tertile III vs. tertiles I and II, p=0.001). However, restenosis rates were similar in all three groups (9.1% vs. 11.4% vs. 11.6%, respectively, p=0.3).

Conclusions Preprocedural CRP levels were significantly associated with major coronary events after DES implantation. However preprocedural CRP levels do not predict subsequent restenosis. Baseline CRP levels may be useful to guide adjunctive management for preventing serious ischemic events in patients undergoing DES implantation.

Keywords: coronary artery disease, inflammation, stents

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