Preprocedural C-reactive protein levels predict stroke and death in patients undergoing carotid stenting.
OBJECTIVE
Elevated baseline levels of C-reactive protein (CRP) are associated with an adverse outcome during coronary stent placement. The aim of this study was to evaluate whether preprocedural CRP levels also are predictive of stroke and death in patients undergoing carotid stent placement (CAS).


METHODS
We reviewed data prospectively collected from 130 patients (97 men, 33 women; mean age, 68.5 +/- 10.1 years; range, 43-89 years) who underwent CAS for symptomatic carotid stenosis and from whom preprocedural CRP values had been obtained. A CRP value of >5 mg/L was considered to be elevated. The frequency of stroke and death within 30 days was compared between patients with and without elevated baseline CRP levels using chi(2) and multivariate logistic regression analysis.


RESULTS
Baseline CRP values were normal in 94 (72.3%) patients but were elevated in 36 (27.7%) patients. The demographic and clinical characteristics were similar in both treatment groups. The 30-day stroke and death rate was significantly higher in patients with elevated CRP values (8/36; 22.2%) than in those without (3/94; 3.2%; P < .01). After adjusting for demographic characteristics, degree of carotid stenosis, and use of cerebral protection devices and/or statin therapy, an elevated CRP value before CAS remained a significant and independent predictor of stroke and death within 30 days after CAS (odds ratio, 7.7; 95% confidence interval: 1.8-32.8, P = .006).


CONCLUSIONS
Baseline CRP is a powerful predictor of outcome in patients undergoing CAS, which underscores the role of inflammation in the pathogenesis of embolic complications during this procedure.
Gröschel
K
K
Department of Neurology, University of Göttingen, Göttingen, Germany.
Ernemann
U
U
Larsen
J
J
Knauth
M
M
Schmidt
F
F
Artschwager
J
J
Kastrup
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data*; D002097:C-Reactive Protein / Q000032:analysis*; D016893:Carotid Stenosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods* / Q000706:statistics & numerical data; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D015607:Stents / Q000706:statistics & numerical data*; D020521:Stroke / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome
D002097:C-Reactive Protein