Association between percutaneous coronary intervention and long-term C-reactive protein levels in patients with acute coronary syndromes.
C-reactive protein (CRP) is an independent predictor of risk in ACS patients, and it has been previously shown that percutaneous coronary intervention (PCI) is associated with an early rise in CRP. To assess the long-term relationship between PCI and CRP, we compared CRP levels at baseline, 30 days, 4 months and 24 months among patients in the Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 trial who were treated with PCI and those who did not receive PCI. At study entry, CRP was significantly higher among patients who had undergone PCI (13.2 vs. 9.5 mg/l, P < 0.001). However, by day 30 CRP was significantly lower among patients who had undergone PCI for management of the index event (1.5 vs. 2.1 mg/l, P < 0.001) and remained lower at 4 months and by end of study (average 2 years after ACS). Using a multivariable model, we observed that PCI was associated with 8.6% lower CRP level at month 4 (P = 0.05) and 14.2% at approximately 2 years (P = 0.0028). These analyses suggest that although PCI may acutely increase inflammation, it may also serve a role in decreasing inflammation associated with atherosclerotic plaques via long-term mechanical stabilization.
Ray
Kausik K
KK
Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
Nazer
Babak
B
Cairns
Richard
R
Michael Gibson
C
C
Cannon
Christopher P
CP
D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D050197:Atherosclerosis / Q000473:pathology; D000069059:Atorvastatin; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006538:Heptanoic Acids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007249:Inflammation / Q000209:etiology; D008297:Male; D008875:Middle Aged; D019370:Observation; D017035:Pravastatin / Q000627:therapeutic use; D011758:Pyrroles / Q000627:therapeutic use; D016896:Treatment Outcome
D006538:Heptanoic Acids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D011758:Pyrroles; D002097:C-Reactive Protein; D000069059:Atorvastatin; D017035:Pravastatin