Preprocedural serum levels of C-reactive protein predict early complications and late restenosis after coronary angioplasty

OBJECTIVES We sought to investigate whether early and late outcome after pe rcutaneous transluminal coronary angioplasty (PTCA) could be predicted by b aseline levels of acute-phase reactants. BACKGROUND Although some risk factors for acute complications and restenosi s have been identified, an accurate preprocedural risk stratification of pa tients undergoing PTCA is still lacking. METHODS Levels of C-reactive protein (CRP), serum amyloid A protein (SAA) a nd fibrinogen were measured in 52 stable angina and 69 unstable angina pati ents undergoing single vessel PTCA. RESULTS Tertiles of CRP levels (relative risk [RR] = 12.2, p < 0.001), syst emic hypertension (RR = 4.3, p = 0.046) and female gender (RR = 4.1, p = 0. 033) were the only independent predictors of early adverse events. Intrapro cedural and in-hospital complications were observed in 22% of 69 patients w ith high serum levels (>0.3 mg/dl) of CRP and in none of 52 patients with n ormal CRP levels (p < 0.001). Tertiles of CRP levels (RR = 6.2, p = 0.001), SAA levels (RR = 6.0, p = 0.011), residual stenosis (RR = 3.2, p = 0.007) and acute gain (RR = 0.3, p = 0.01) were the only independent predictors of clinical restenosis. At one-year follow-up, clinical restenosis da eloped in 63% of patients with high CRP levels and in 27% of those with normal CRP levels (p < 0.001). CONCLUSIONS Preprocedural CRP level, an easily measurable marker of acute p hase response, is a powerful predictor of both early and late outcome in pa tients undergoing single vessel PTCA, suggesting that early complications a nd clinical restenosis are markedly influenced by the preprocedural degree of inflammatory tell activation. (C) 1999 by the American College of Cardio logy.