title: Combined periprocedural evaluation of CRP and TNF-alpha enhances the prediction of clinical restenosis and major adverse cardiac events in patients undergoing percutaneous coronary interventions.
abstract: To assess the value of serial C-reactive protein (CRP), serum amyloid A (SAA), tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) evaluation in the risk stratification in patients undergoing percutaneous coronary intervention. The study was designed as a prospective cohort trial with a 1-year follow-up. Eighty patients (70 with stable angina, 10 with unstable angina) were enrolled. Blood samples were collected before the procedure and after 6 and 24 h, and 1 month. Clinical follow-up visits were performed (*with exercise test) 7 days* and 1*, 3, 6* and 12 months after the procedure. Any symptoms of restenosis were verified angiographically. Multivariate logistic regression analysis identified increased preprocedural TNF-alpha and CRP levels and elevated CRP concentrations evaluated 24 h after the procedure as significant predictors of both clinical restenosis and major adverse cardiac events (MACE), while high SAA values at 24 h accurately predicted clinical restenosis. Patients, who were in the highest tertile of, either, baseline TNF-alpha and/or baseline CRP/CRP at 24 h, were more prone to develop restenosis and MACE than stratified only on the basis of a single marker. Our data indicate that combined analysis of CRP and TNF-alpha might be an effective approach to the clinical restenosis and MACE prediction. Additionally, long-term outcome is markedly influenced by the periprocedural activation of inflammation.
authors.affiliation: Department of Cardiology and Internal Diseases, The Ludwik Rydygier Medical University, Sklodowskiej-Curie Street 9, Bydgoszcz 85-094, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.forename: Marek
authors.initials: M
authors.lastname: Kozinski
authors.forename: Anna
authors.initials: A
authors.lastname: Krzewina-Kowalska
authors.forename: Magdalena
authors.initials: M
authors.lastname: Zbikowska-Gotz
authors.forename: Grazyna
authors.initials: G
authors.lastname: Dymek
authors.forename: Adam
authors.initials: A
authors.lastname: Sukiennik
authors.forename: Radoslaw
authors.initials: R
authors.lastname: Piasecki
authors.forename: Maria
authors.initials: M
authors.lastname: Bogdan
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Grzesk
authors.forename: Maciej
authors.initials: M
authors.lastname: Chojnicki
authors.forename: Andrzej
authors.initials: A
authors.lastname: Dziedziczko
authors.forename: Grazyna
authors.initials: G
authors.lastname: Sypniewska
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D023903:Coronary Restenosis / Q000097:blood* / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein