Is C-reactive protein a prognostic marker after angioplasty?

C-reactive protein (CRP), an acute phase reactant and a strong marker of inflammation, has been found repeatedly to be a strong predictor of future cardiovascular events1 and a marker of statin treatment in apparently healthy subjects without hyperlipidaemia.2 Recently, the Jupiter trial2 used CRP as the unique inflammatory marker to investigate the impact of rosuvastatin treatment on cardiovascular events. The study enrolled healthy men and women with low-density lipoprotein cholesterol levels of less than 130 mg/dl and high-sensitivity (hs) CRP levels of 2.0 mg/l or higher. Rosuvastatin reduced low-density lipoprotein cholesterol levels by 50% and hsCRP levels by 37%. Importantly, the decrease in CRP levels was accompanied by a significant reduction in the incidence of major cardiovascular events. As a result of the important role of inflammation in cardiovascular disease and the prognostic value of CRP, preprocedural measurement of CRP has been proposed to be a tool in identifying patients at higher risk of restenosis and recurrent events. However, the association between CRP levels and the events occurring after percutaneous coronary intervention (PCI) remains uncertain and still under investigation.

PROGNOSTIC ROLE OF CRP AFTER PCI

Several studies have examined the prognostic role of CRP levels after elective or emergent PCI with a positive prognostic impact (table 1).

Elective PCI studies

A study carried by Buffon et al3 investigated whether early and late outcome after PCI could be predicted by baseline levels of acute phase reactants such as CRP. This study demonstrated that preprocedural CRP is a powerful predictor of both early and late outcome in patients undergoing single-vessel PCI. Similarly, CRP was found to predict death, myocardial infarction …