Published Online
on March 24, 2003

A more recent version of this article appeared on April 8, 2003

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Submitted on October 9, 2002
Revised on December 31, 2002
Accepted on January 16, 2003

Relation of Inflammation and Benefit of Statins After Percutaneous Coronary Interventions

Albert W. Chan MD, MSc^*, Deepak L. Bhatt MD, Derek P. Chew MBBS, MPH, Joel Reginelli MD, Jakob P. Schneider RN, Eric J. Topol MD, and Stephen G. Ellis MD

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.).

^* To whom correspondence should be addressed. 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

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