title: Long-term prognostic value of preprocedural C-reactive protein after drug-eluting stent implantation.
abstract: C-reactive protein (CRP) elevation is associated with an adverse cardiovascular prognosis after bare metal stent implantation. Data have suggested a similar association between preprocedural CRP and adverse events after drug-eluting stent (DES) implantation. The present study was designed to address whether such a relation exists after DES placement. After excluding patients presenting with an acute coronary syndrome with troponin I elevation, we analyzed the data from 936 consecutive patients who had undergone DES implantation from 2003 to 2007 and had a preprocedural CRP measurement. The patients were divided into 3 groups according to the preprocedural CRP level (<1.31, 1.31-3.76, and >3.76 mg/L). The primary end point was the composite of death and Q-wave myocardial infarction (QWMI) at 2 years of follow-up. Target vessel revascularization was also assessed. The rate of death/QWMI was not significantly different statistically among the CRP tertiles during the in-hospital period (0.6% vs 0.0% vs 0.6%, p = 0.5) or at 1 year of follow-up (1.9% vs 2.9% vs 4.5%, p = 0.2). At 2 years, death/QWMI had occurred in 2.9% of patients in the lowest, 5.2% in the middle, and 8.8% in the highest tertile (p = 0.006). The incidence of target vessel revascularization was similar in the 3 groups at 2 years of follow-up (13.2% vs 14.9% vs 16.9%, p = 0.5). On multivariate analysis, the upper tertile of CRP was an independent predictor of death/QWMI at 2 years (hazard ratio 2.5, 95% confidence interval 1.1 to 5.4, tertile 3 vs tertile 1, p = 0.006). In conclusion, high preprocedural CRP levels are associated with an increased risk of death and QWMI after DES implantation at long-term follow-up but not acutely. The CRP levels were not related to target vessel revascularization. Thus, an elevated CRP level in this population appears to be more of a marker of global cardiovascular risk than a predictor of post-DES-related complications.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, District of Columbia.
authors.forename: Cedric
authors.initials: C
authors.lastname: Delhaye
authors.forename: Gabriel
authors.initials: G
authors.lastname: Maluenda
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Itsik
authors.initials: I
authors.lastname: Ben-Dor
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.forename: Sara D
authors.initials: SD
authors.lastname: Collins
authors.forename: Asmir I
authors.initials: AI
authors.lastname: Syed
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaneshige
authors.forename: Zhenyi
authors.initials: Z
authors.lastname: Xue
authors.forename: William O
authors.initials: WO
authors.lastname: Suddath
authors.forename: Lowell F
authors.initials: LF
authors.lastname: Satler
authors.forename: Kenneth M
authors.initials: KM
authors.lastname: Kent
authors.forename: Joseph
authors.initials: J
authors.lastname: Lindsay
authors.forename: Augusto D
authors.initials: AD
authors.lastname: Pichard
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D018572:Disease-Free Survival; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein