title: Usefulness of preprocedure high-sensitivity C-reactive protein to predict death, recurrent myocardial infarction, and stent thrombosis according to stent type in patients with ST-segment elevation myocardial infarction randomized to bare metal or drug-eluting stenting during primary percutaneous coronary intervention.
abstract: It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2 mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently predicted the composite end point of death and MI at 36-month follow-up. There was a significant interaction (p = 0.006) for hs-CRP and stent type. Survival analysis demonstrated significant differences for occurrence of death and MI: 4.8% in BMS + CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS + CRP ≤2 mg/L. In conclusion, preprocedure hs-CRP predicts outcome after pPCI in patients with STEMI. Our hypothesis-generating data indicate that BMS implantation should be preferred when hs-CRP is ≤2 mg/L and DES when hs-CRP is >2 mg/L to decrease long-term adverse outcomes including stent thrombosis in patients with STEMI treated with pPCI. These findings need confirmation in larger randomized clinical trials.
authors: Department of Cardiology and Cardiac Catheterization Laboratory, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. mikkel.schoos@gmail.com
authors: Mikkel Malby
authors: MM
authors: Schoos
authors: Henning
authors: H
authors: Kelbæk
authors: Klaus F
authors: KF
authors: Kofoed
authors: Lars
authors: L
authors: Køber
authors: Lene
authors: L
authors: Kløvgaard
authors: Steffen
authors: S
authors: Helqvist
authors: Thomas
authors: T
authors: Engstrøm
authors: Kari
authors: K
authors: Saunamäki
authors: Erik
authors: E
authors: Jørgensen
authors: Lene
authors: L
authors: Holmvang
authors: Peter
authors: P
authors: Clemmensen
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000032:analysis*; D003328:Coronary Thrombosis / Q000097:blood* / Q000209:etiology; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000628:therapy*; D011237:Predictive Value of Tests; D012008:Recurrence
chemical_list: D002097:C-Reactive Protein