title: Preprocedural C-reactive protein is not associated with angiographic restenosis or target lesion revascularization after coronary artery stent placement.
abstract: BACKGROUND
  We assessed the predictive value of preprocedural plasma C-reactive protein (CRP) concentrations and statin therapy on 6 months angiographic and 1-year clinical outcome after nonurgent coronary stent placement.
  
  
  RESULTS
  Baseline plasma high-sensitivity CRP concentrations were prospectively measured in 345 patients undergoing elective stent placement in a native coronary artery. The binary angiographic in-stent restenosis (ISR; stenosis > or = 50% of vessel diameter) rate was 19% in patients with CRP values within the reference interval (< or = 3 mg/L) and 22% in patients with CRP >3 mg/L [odds ratio (OR) = 1.2; 95% confidence interval (CI), 0.73-2.09]. Statin therapy in a univariate analysis significantly reduced both angiographic and clinical ISR rates. Multivariate logistic regression analysis identified unstable angina, smoking, and stent length, but neither CRP concentration nor statin therapy as independent predictors for angiographic ISR. Patients with an abnormal CRP value showed a trend toward a higher risk of nonfatal myocardial infarction (3.8% vs 0.5%; OR = 7.43; 95% CI, 0.87-61.65). Target lesion revascularization rates did not differ between the two groups (9.6% vs 10.6%; OR = 1.13; 95% CI, 0.56-2.28). In multivariate analysis, male sex (OR = 0.44, 95% CI, 0.19-0.97) and statin therapy (OR = 0.26; 95% CI, 0.09-0.68) were independent predictors for the occurrence of target lesion revascularization.
  
  
  CONCLUSIONS
  This study demonstrated a lack of association between preprocedural plasma CRP concentrations and angiographic coronary ISR or clinically driven target lesion revascularization. Patients with an abnormal CRP concentration showed a trend toward higher risk of nonfatal myocardial infarction during 1 year of follow-up. Statin therapy was independently associated with decreased clinically driven target lesion revascularization, underlining the beneficial effects of statins on clinical outcome.
authors.affiliation: Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: Saskia Z H
authors.initials: SZ
authors.lastname: Rittersma
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: de Winter
authors.forename: Karel T
authors.initials: KT
authors.lastname: Koch
authors.forename: Carl E
authors.initials: CE
authors.lastname: Schotborgh
authors.forename: Matthijs
authors.initials: M
authors.lastname: Bax
authors.forename: Gerlind S
authors.initials: GS
authors.lastname: Heyde
authors.forename: Jan P
authors.initials: JP
authors.lastname: van Straalen
authors.forename: Karla J
authors.initials: KJ
authors.lastname: Mulder
authors.forename: Jan G P
authors.initials: JG
authors.lastname: Tijssen
authors.forename: Gerard T
authors.initials: GT
authors.lastname: Sanders
authors.forename: Jan J
authors.initials: JJ
authors.lastname: Piek
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000601:surgery / Q000628:therapy*; D023903:Coronary Restenosis / Q000097:blood* / Q000517:prevention & control; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015607:Stents
chemical_list: D000924:Anticholesteremic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002097:C-Reactive Protein