Incremental prognostic value of elevated baseline C-reactive protein amongestablished markers of risk in percutaneous coronary intervention

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.