Association between C-reactive protein levels and subsequent cardiac events among patients with stable angina treated with coronary artery stenting.
OBJECTIVE
To investigate the prognostic value of elevated C-reactive protein levels in patients with stable angina who underwent coronary stenting.


METHODS
We followed a consecutive series of 1152 patients with stable angina who had undergone coronary stenting. We measured baseline C-reactive protein levels before stenting with a high-sensitivity assay; 651 patients (57%) had elevated C-reactive protein levels (>5 mg/L). The primary endpoint was either death or myocardial infarction within 1 year after the procedure. Angiographic restenosis was defined as a > or =50% diameter stenosis at follow-up angiography.


RESULTS
During the 1-year follow-up, 62 (9.5%) of the 651 patients with an elevated C-reactive protein level and 24 (4.8%) of the 501 patients with normal levels died or had a myocardial infarction (P = 0.002). In a multivariate analysis, elevated baseline C-reactive protein levels were associated with almost a twofold increase in the rate of death or myocardial infarction after coronary stenting (hazard ratio = 1.8; 95% confidence interval: 1.1 to 2.9). Most of the difference in the event rates developed within the first 30 days. Baseline C-reactive protein levels did not correlate with restenosis.


CONCLUSIONS
Elevated preprocedural C-reactive protein levels are associated with a less favorable prognosis in patients with stable angina who undergo coronary stenting. The measurement of C-reactive protein levels in these patients may help to identify those who may benefit from a treatment strategy aimed at the attenuation of inflammation.
Dibra
Alban
A
Deutsches Herzzentrum and Medizinische Klinik rechts der Isar, Technische Universität Mnchen, Munich, Germany.
Mehilli
Julinda
J
Braun
Siegmund
S
Hadamitzky
Martin
M
Baum
Hannsjörg
H
Dirschinger
Josef
J
Schühlen
Helmut
H
Schömig
Albert
A
Kastrati
Adnan
A
D000787:Angina Pectoris / Q000097:blood / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000378:metabolism*; D016757:Death, Sudden, Cardiac; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality*; D011184:Postoperative Period; D011300:Preoperative Care; D015607:Stents; D016019:Survival Analysis
D002097:C-Reactive Protein