Predictive value of preintervention C-reactive protein on clinical outcome after directional coronary atherectomy followed by stent implantation.
BACKGROUND
Preprocedural C-reactive protein (CRP) serum levels have been shown to predict the recurrence of angina or major adverse cardiac events after percutaneous coronary intervention. Directional coronary atherectomy (DCA), by reducing residual plaque burden and restenosis, has been shown to improve clinical outcome after coronary stenting. Thus, we assessed the influence of preprocedural CRP serum levels on the recurrence of cardiac events after DCA followed by bare metal stent implantation.


METHODS
We enrolled 40 consecutive patients (34 males; 61+/-10 years old) with single-vessel disease who were undergoing DCA. In all patients, preprocedural CRP serum levels were measured by an ultrasensitive nephelometric method. The endpoint of the study was defined as the composite incidence of death, myocardial infarction, and recurrence of angina requiring repeat revascularization at 6-month follow-up.


RESULTS
CRP serum levels were a significant independent predictor of the composite endpoint at multiple regression analysis [odds ratio=1.69; 95% confidence interval (95% CI)=1.04-2.75; P=.033]. Patients with recurrence of cardiac events had CRP serum levels higher than those of patients not having events on follow-up [3.95 (2.2-5.7) vs. 2 (1.3-3.3); P=.05].


CONCLUSIONS
In conclusion, our study shows that baseline CRP serum levels predict cardiac events after coronary bare metal stenting despite plaque debulking with directional atherectomy.
Niccoli
Giampaolo
G
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. gniccoli73@hotmail.it
Ferrante
Giuseppe
G
Mongiardo
Rocco
R
Perfetti
Matteo
M
Belloni
Flavia
F
Burzotta
Francesco
F
Porto
Italo
I
Leone
Antonio Maria
AM
Rebuzzi
Antonio G
AG
Crea
Filippo
F
D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000209:etiology* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation*; D017225:Atherectomy, Coronary; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D023903:Coronary Restenosis / Q000097:blood / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008670:Metals; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology; D009391:Nephelometry and Turbidimetry / Q000379:methods; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
D008670:Metals; D002097:C-Reactive Protein