Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation

OBJECTIVES This study assessed the predictive value of preprocedural C-reac tive protein (CRP) levels on six-month clinical and angiographic outcome in patients undergoing coronary stent implantation. BACKGROUND Recent data indicate that low-grade inflammation as detected by elevated CRP serum levels predicts the risk of recurrent coronary events. METHODS We prospectively investigated the predictive value of preprocedural CRP-levels on restenosis and six-month clinical outcome in 276 patients af ter coronary stent implantation. The primary combined end point was death d ue to cardiac causes, myocardial infarction related to the target vessel an d repeat intervention of the stented vessel. RESULTS Grouping patients into tertiles according to preprocedural CRP-leve ls revealed that, despite identical angiographic and clinical characteristi cs at baseline and after stent implantation, a primary end point event occu rred in 24 (26%) patients of the lowest tertile, in 42 (45.6%) of the middl e tertile and in 38 (41.3%) of the highest CRP tertile, p = 0.01. On multiv ariate analysis, tertiles of CRP levels were independently associated with a higher risk of adverse coronary events (relative: risk = 2.0 [1.1 to 3.5] , tertile I vs. II and III, p = 0.01) in addition to the minimal lumen diam eter after stent (p = 0.04). In addition, restenosis rates were significant ly higher in the two upper tertiles compared with CRP levels in the lowest tertile (45.5% vs. 38.3% vs. 18.5%, respectively, p = 0.002). CONCLUSIONS Low-grade inflammation as evidenced by elevated preprocedural s erum CRP-levels is an independent predictor of adverse outcome after corona ry stent implantation, suggesting that a systemically detectable inflammato ry activity is associated with proliferative responses within successfully implanted stents. (J Am Coil Cardiol 2001;37:839-46) (C) 2001 by the Americ an College of Cardiology.