Association between C-reactive protein and angiographic restenosis after bare metal stents: an updated and comprehensive meta-analysis of 2747 patients.
BACKGROUND
Previous studies have shown conflicting results about the relationship between baseline C-reactive protein (CRP) and restenosis after stenting with bare metal stent (BMS).


METHODS
We assessed the association between serum CRP and angiographic restenosis after BMS by meta-analysis. Studies that reported basal serum CRP levels, above a prespecified cutoff value, before BMS deployment were included. An inverse random weighted meta-analysis was performed by entering the logarithm of the odds ratio (OR) of angiographic restenosis with its standard error for each study.


RESULTS
Nine studies enrolling 2747 patients were selected. CRP threshold value was around 3 mg/l in three studies, 5 mg/l in four studies, and 6.98 and 10 mg/l in one study. Follow-up duration was 6.2+/-3.0 (mean+/-S.D.) months. Higher preprocedural CRP levels were a significant predictor of angiographic restenosis: OR 1.59, 95% confidence interval 1.21-2.07, P=.001. Heterogeneity was found: chi2 14.47, P=.07; I2=44.7%. Publication bias was also detected (P=.01, Egger's test). A sensitivity analysis, after excluding each study in turn, confirmed the predictive value of higher CRP levels, in agreement with the results of the main analysis.


CONCLUSIONS
Among patients with coronary artery disease, undergoing percutaneous coronary intervention with BMS, higher baseline CRP levels are associated with higher risk of angiographic restenosis. A targeted therapeutic approach to patients with high baseline CRP, based on statins, oral corticosteroids, or PPAR gamma agonists, or selective use of drug-eluting stents, aiming at abating the higher risk of in-stent restenosis should be considered.
Ferrante
Giuseppe
G
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. giu.ferrante@hotmail.it
Niccoli
Giampaolo
G
Biasucci
Luigi M
LM
Liuzzo
Giovanna
G
Burzotta
Francesco
F
Galiuto
Leonarda
L
Trani
Carlo
C
Rebuzzi
Antonio G
AG
Crea
Filippo
F
D000924:Anticholesteremic Agents / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D017023:Coronary Angiography / Q000379:methods*; D023903:Coronary Restenosis / Q000097:blood* / Q000000981:diagnostic imaging; D006801:Humans; D011237:Predictive Value of Tests; D011475:Prosthesis Failure; D015607:Stents
D000924:Anticholesteremic Agents; D002097:C-Reactive Protein