Published online before print March 24, 2003, doi: 10.1161/01.CIR.0000060541.18923.E9
| |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;107:1750.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Relation of Inflammation and Benefit of Statins After Percutaneous Coronary Interventions
From the Department of Cardiology, Ochsner Clinic Foundation, New Orleans, La (A.W.C.); Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (D.L.B., J.R., J.P.S., E.J.T., S.G.E.); and Division of Cardiology, Flinders Medical Center, Australia (D.P.C.).
Correspondence to Albert W. Chan, MD, Associate Director, Catheterization Laboratory, Department of Cardiology, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121. E-mail achan{at}ochsner.org
Background— Beyond lipid lowering, statins are known to possess antiinflammatory and antithrombotic properties. Recent studies suggested an association between statins and early reduction in death or myocardial infarction (MI) after percutaneous coronary interventions (PCIs). We sought to examine the interrelationship between inflammation, statin use, and PCI outcomes.
Methods and Results— In the year 2000, 1552 consecutive United States residents underwent elective or urgent PCI at the Cleveland Clinic and were prospectively followed for 1 year. Preprocedural serum high-sensitivity C-reactive protein (hsCRP) levels were routinely measured. Patients who had statins initiated before the procedure (39.6%) had a lower median hsCRP level (0.40 versus 0.50 mg/dL, P=0.012) independent of the baseline cholesterol levels and had less frequent periprocedural MI (defined by CKMB 
3xupper limit of normal, 5.7% versus 8.1%, P=0.038). At 1 year, statin pretreatment was predictive of survival predominantly among patients within the highest hsCRP quartile (mortality rate with statin pretreatment versus no pretreatment when hsCRP 1.11 mg/dL, 5.7% versus 14.8%, P=0.009). Using multivariate analysis, preprocedural hsCRP level remained an independent predictor for 1-year death or MI only in patients without statin therapy (hazard ratio, 1.32/quartile; P=0.001). After adjusting for the propensity of receiving statins, statin pretreatment was an independent predictor for 1-year survival within the highest hsCRP quartile (hazard ratio, 0.44; P=0.039).
Conclusions— Statin therapy before PCI is associated with a marked reduction in mortality among patients with high hsCRP levels. A hsCRP-guided strategy may improve targeting of statin therapy and clinical outcome among patients undergoing PCI.
Key Words: angioplasty • coronary disease • inflammation • statins • stents
This article has been cited by other articles:
 |
|
 |
|
  G. Heusch, P. Kleinbongard, D. Bose, B. Levkau, M. Haude, R. Schulz, and R. Erbel Coronary Microembolization: From Bedside to Bench and Back to Bedside Circulation, November 3, 2009; 120(18): 1822 - 1836. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Montalescot, H. Drexler, R. Gallo, T. Pearson, M. Thoenes, and D. L. Bhatt Effect of irbesartan and enalapril in non-ST elevation acute coronary syndrome: results of the randomized, double-blind ARCHIPELAGO study Eur. Heart J., November 2, 2009; 30(22): 2733 - 2741. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. S. Choi, J. K. Shim, S. W. Hong, D. H. Kim, J. C. Kim, and Y. L. Kwak Risk factors of atrial fibrillation following off-pump coronary artery bypass graft surgery: predictive value of C-reactive protein and transfusion requirement Eur. J. Cardiothorac. Surg., November 1, 2009; 36(5): 838 - 843. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Hara, M. Nakamura, I. Yokouchi, K. Kimura, N. Nemoto, S. Ito, T. Ono, H. Itaya, M. Shiba, M. Wada, et al. Aggressive statin therapy in multicenter and effectiveness for the reduction of intra-myocardial damage caused by non-ST elevation acute coronary syndrome: AMERICA study Therapeutic Advances in Cardiovascular Disease, October 1, 2009; 3(5): 357 - 365. [Abstract] [PDF]
|
|
|
|
 |
|
 S. G. Ellis and S. Anwaruddin Recapturing the Magic: Revisiting the Pleiotropic Effects of Statins in Percutaneous Coronary Revascularization J. Am. Coll. Cardiol., August 4, 2009; 54(6): 566 - 568. [Full Text] [PDF]
|
|
|
|
|
|
R. Jaumdally, C. Varma, R. J. Macfadyen, and G. Y.H. Lip Coronary sinus blood sampling: an insight into local cardiac pathophysiology and treatment? Eur. Heart J., April 2, 2007; 28(8): 929 - 940. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Collard, S. C. Body, S. K. Shernan, S. Wang, D. T. Mangano, and Multicenter Study of Perioperative Ischemia (MCSPI Preoperative statin therapy is associated with reduced cardiac mortality after coronary artery bypass graft surgery. J. Thorac. Cardiovasc. Surg., August 1, 2006; 132(2): 392 - 400. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. -K. Yip, C. -H. Lu, C. -H. Yang, H. -W. Chang, W. -C. Hung, C. -I. Cheng, S. -M. Chen, and C. -J. Wu Levels and value of platelet activity in patients with severe internal carotid artery stenosis Neurology, March 28, 2006; 66(6): 804 - 808. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Iwakura, H. Ito, S. Kawano, A. Okamura, T. Kurotobi, M. Date, K. Inoue, and K. Fujii Chronic pre-treatment of statins is associated with the reduction of the no-reflow phenomenon in the patients with reperfused acute myocardial infarction Eur. Heart J., March 1, 2006; 27(5): 534 - 539. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Pascual, J. M. Arribas, P. L. Tornel, F. Marin, C. Oliver, M. Ahumada, J. Gomez-Plana, P. Martinez, R. Arcas, and M. Valdes Preoperative Statin Therapy and Troponin T Predict Early Complications of Coronary Artery Surgery Ann. Thorac. Surg., January 1, 2006; 81(1): 78 - 83. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Hindler, C. S. Cleeland, E. Rivera, and C. D. Collard The Role of Statins in Cancer Therapy. Oncologist, January 1, 2006; 11(3): 306 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Jaschke, C. Michaelis, S. Milz, M. Vogeser, T. Mund, L. Hengst, A. Kastrati, A. Schomig, and R. Wessely Local statin therapy differentially interferes with smooth muscle and endothelial cell proliferation and reduces neointima on a drug-eluting stent platform Cardiovasc Res, December 1, 2005; 68(3): 483 - 492. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
|
|
S. Susen, K. Sautiere, F. Mouquet, F. Cuilleret, A. Chmait, E. P. McFadden, B. Hennache, F. Richard, P. de Groote, J.-M. Lablanche, et al. Serum hepatocyte growth factor levels predict long-term clinical outcome after percutaneous coronary revascularization Eur. Heart J., November 2, 2005; 26(22): 2387 - 2395. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. De Servi, M. Mariani, G. Mariani, and A. Mazzone C-Reactive Protein Increase in Unstable Coronary Disease: Cause or Effect? J. Am. Coll. Cardiol., October 18, 2005; 46(8): 1496 - 1502. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S.-J. Park Inflammatory Biomarkers for Prediction of Outcomes After Unprotected Left Main Coronary Intervention Circulation, October 11, 2005; 112(15): 2226 - 2227. [Full Text] [PDF]
|
|
|
|
 |
|
 R. F. Bonvini, T. Hendiri, and E. Camenzind Inflammatory response post-myocardial infarction and reperfusion: a new therapeutic target? Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I27 - I36. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Bhatt and E. J. Topol Periprocedural Cardiac Enzyme Elevation Predicts Adverse Outcomes Circulation, August 9, 2005; 112(6): 906 - 922. [Full Text] [PDF]
|
|
|
|
 |
|
 G. C. Fonarow, C. W. Yancy, J. T. Heywood, and for the ADHERE Scientific Advisory Committee, Stud Adherence to Heart Failure Quality-of-Care Indicators in US Hospitals: Analysis of the ADHERE Registry Arch Intern Med, July 11, 2005; 165(13): 1469 - 1477. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Steiner, W. S. Speidl, J. Pleiner, D. Seidinger, G. Zorn, C. Kaun, J. Wojta, K. Huber, E. Minar, M. Wolzt, et al. Simvastatin Blunts Endotoxin-Induced Tissue Factor In Vivo Circulation, April 12, 2005; 111(14): 1841 - 1846. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Briguori, A. Colombo, F. Airoldi, A. Violante, A. Focaccio, P. Balestrieri, P. Paolo Elia, B. Golia, S. Lepore, G. Riviezzo, et al. Statin administration before percutaneous coronary intervention: impact on periprocedural myocardial infarction Eur. Heart J., October 2, 2004; 25(20): 1822 - 1828. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Toutouzas, A. Colombo, and C. Stefanadis Inflammation and restenosis after percutaneous coronary interventions Eur. Heart J., October 1, 2004; 25(19): 1679 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Pan, T. Pintar, J. Anton, V.-V. Lee, W. K. Vaughn, and C. D. Collard Statins Are Associated With a Reduced Incidence of Perioperative Mortality After Coronary Artery Bypass Graft Surgery Circulation, September 14, 2004; 110(11_suppl_1): II-45 - II-49. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T.-S. Lee, C.-C. Chang, Y. Zhu, and J. Y.-J. Shyy Simvastatin Induces Heme Oxygenase-1: A Novel Mechanism of Vessel Protection Circulation, September 7, 2004; 110(10): 1296 - 1302. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Morrow Preprocedural C-Reactive Protein for Risk Prediction Before Percutaneous Coronary Intervention (PCI): A US Perspective Clin. Chem., September 1, 2004; 50(9): 1489 - 1491. [Full Text] [PDF]
|
|
|
|
|
|
S. Z.H. Rittersma, R. J. de Winter, K. T. Koch, C. E. Schotborgh, M. Bax, G. S. Heyde, J. P. van Straalen, K. J. Mulder, J. G.P. Tijssen, G. T. Sanders, et al. Preprocedural C-Reactive Protein Is Not Associated with Angiographic Restenosis or Target Lesion Revascularization after Coronary Artery Stent Placement Clin. Chem., September 1, 2004; 50(9): 1589 - 1596. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Pasceri, G. Patti, A. Nusca, C. Pristipino, G. Richichi, G. Di Sciascio, and on behalf of the ARMYDA Investigators Randomized Trial of Atorvastatin for Reduction of Myocardial Damage During Coronary Intervention: Results From the ARMYDA (Atorvastatin for Reduction of MYocardial Damage during Angioplasty) Study Circulation, August 10, 2004; 110(6): 674 - 678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schillinger, M. Exner, W. Mlekusch, J. Amighi, S. Sabeti, M. Muellner, H. Rumpold, O. Wagner, and E. Minar Statin therapy improves cardiovascular outcome of patients with peripheral artery disease Eur. Heart J., May 1, 2004; 25(9): 742 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M Backes, P. A Howard, and P. M Moriarty Role of C-Reactive Protein in Cardiovascular Disease Ann. Pharmacother., January 1, 2004; 38(1): 110 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M Ridker and on behalf of the JUPITER Study Group Rosuvastatin in the Primary Prevention of Cardiovascular Disease Among Patients With Low Levels of Low-Density Lipoprotein Cholesterol and Elevated High-Sensitivity C-Reactive Protein: Rationale and Design of the JUPITER Trial* Circulation, November 11, 2003; 108(19): 2292 - 2297. [Full Text] [PDF]
|
|
|
|
|
|
D. J. Kereiakes Adjunctive Pharmacotherapy before Percutaneous Coronary Intervention in Non-ST-Elevation Acute Coronary Syndromes: The Role of Modulating Inflammation Circulation, October 21, 2003; 108(90161): III-22 - 27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. K. Nallamothu and E. R. Bates Periprocedural myocardial infarction and mortality: Causality versus association J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1412 - 1414. [Full Text] [PDF]
|
|
|
|
|
|
J. J. Piek and R. J. de Winter Type II secretory phospholipase A2: The emerging role of biochemical markers of plaque inflammation Eur. Heart J., October 2, 2003; 24(20): 1804 - 1806. [Full Text] [PDF]
|
|
|
|
 |
|
 Pre-PCI CRP Levels and Statin Use Journal Watch Cardiology, July 11, 2003; 2003(711): 3 - 3. [Full Text]
|
|