Preprocedural C-Reactive Protein levels and Clinical Outcomes after Percutaneous Coronary Interventions With and Without Abciximab: Pooled Analysis of 4 ISAR trials

Raisuke Iijima ^1*, Robert A Byrne ¹, Gjin Ndrepepa ¹, Siegmund Braun ¹, Julinda Mehilli ¹, Peter B Berger ², Albert Schoemig ¹ and Adnan Kastrati ¹

¹ Deutsches Herzzentrum, Germany
² Geisinger Clinic, Danville, Pa, United States

^* To whom correspondence should be addressed. E-mail: raisuke{at}live.jp.

Accepted 26 August 2008

Abstract

Objective: To assess the prognostic value of the baseline C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) after pre-treatment with 600 mg of clopidogrel and whether there is an interaction between CRP level and abciximab in terms of outcome.

Design: Pooled analysis from the ISAR-SWEET, SMART-2, ISAR-REACT, and REACT-2 trials.

Setting, Methods: The study included 4847 patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. The primary outcome was 1-year mortality. The combined incidence of death, myocardial infarction, and target lesion revascularization was the secondary outcome.

Results: Based on the median value of CRP (2.3 mg/L), patients were divided into 2 groups: the high-CRP group (n=2448) and the low-CRP group (n=2399). During 1-year, there were 141 deaths (5.8%) in the high-CRP group versus 51 deaths (2.1%) in the low-CRP group, (OR=2.77, 95%CI 2.04-3.77; p<0.001). The incidence of major adverse cardiac events (MACE) was 28% in the high-CRP group versus 25% in the low-CRP group (OR=1.13, 95%CI 1.01-1.26; p=0.034). The Cox proportional hazards model showed that high-CRP was an independent predictor of 1-year mortality (hazard ratio=2.20, 95%CI 1.54-3.15; P<0.001 for CRP level >2.3mg/L versus. CRP level 2.3mg/L). No significant interaction was observed between CRP level and abciximab regarding one-year mortality (P=0.08) or MACE (P=0.68).

Conclusion: In patients with CAD undergoing PCI after pre-treatment with 600mg of clopidogrel, baseline CRP level predicts 1-year mortality and MACE. Abciximab therapy did not confer any particular beneficial effect in patients with a higher inflammatory burden.