Dp. Chew et al., Incremental prognostic value of elevated baseline C-reactive protein amongestablished markers of risk in percutaneous coronary intervention, CIRCULATION, 104(9), 2001, pp. 992-997
Citations number
20
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Background-Established methods of risk assessment in percutaneous coronary
intervention have focused on clinical and anatomical lesion characteristics
. Emerging evidence indicates the substantial contribution of inflammatory
processes to short-term and long-term outcomes in coronary artery disease.
Methods and Results-Within a single-center registry of contemporary percuta
neous coronary revascularization strategies with postprocedural creatine. k
inase and clinical events routinely recorded, we assessed the association o
f baseline C-reactive protein with death or myocardial infarction within th
e first 30 days. Predictive usefulness of baselines C-reactive protein with
in the context of established clinical and angiographic predictors of risk
was also examined. Among 727 consecutive patients, elevated baseline C-reac
tive protein before percutaneous coronary intervention was associated with
progressive increase in death or myocardial infarction at 30 days (lowest q
uartile, 3.9%, versus highest quartile, 14.2%; P = 0.002). Among clinical a
nd procedural characteristics, baseline C-reactive protein remained indepen
dently predictive of adverse events, with the highest quartile of C-reactiv
e protein associated with an odds ratio for excess 30-day death or myocardi
al infarction of 3.68 (95% CI, 1.51 to 8.99; P = 0.004). A predictive model
that included baseline C-reactive protein quartiles, American College of C
ardiology/American Heart Association lesion score, acute coronary syndrome
presentation, and coronary stenting appears strongly predictive of 30-day d
eath or myocardial infarction within this population (C-statistic, 0.735) a
nd among individual patients (Brier score, 0.006).
Conclusions-Elevated baseline C-reactive protein portends heightened risk o
f 30-day death or myocardial infarction after coronary intervention, Couple
d anatomic, clinical, and inflammatory risk stratification demonstrates str
ong predictive utility among patients undergoing percutaneous coronary inte
rvention and may be useful for guiding future strategies.