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(Circulation. 2005;112:2332-2338.)
© 2005 American Heart Association, Inc.

Interventional Cardiology

Preprocedural Levels of C-Reactive Protein and Leukocyte Counts Predict 9-Month Mortality After Coronary Angioplasty for the Treatment of Unprotected Left Main Coronary Artery Stenosis

Tullio Palmerini, MD; Antonio Marzocchi, MD; Cinzia Marrozzini, MD; Paolo Ortolani, MD; Francesco Saia, MD; Letizia Bacchi-Reggiani, MD; Santo Virzì, MD; Silvia Gianstefani, MD; Angelo Branzi, MD

From Istituto di Cardiologia, Policlinico S. Orsola, University of Bologna, Bologna, Italy.

Reprint requests to Dr Tullio Palmerini, Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola, Via Massarenti 9, 40 138 Bologna, Italy. E-mail tulliopalmerini{at}hotmail.com

Received March 24, 2005; revision received June 28, 2005; accepted June 29, 2005.

Background— An accurate preprocedural risk stratification scheme for patients with unprotected left main coronary artery (ULMCA) stenosis who are undergoing coronary stenting is lacking. We examined the predictive value of preprocedural levels of C-reactive protein (CRP), fibrinogen, and leukocyte counts with respect to 9-month clinical outcomes after stenting of the ULMCA stenosis.

Methods and Results— Levels of CRP, fibrinogen, and leukocyte count were prospectively measured in 83 patients undergoing stenting of the ULMCA. A drug-eluting stent was used in 42 patients, and a bare metal stent was used in 41. The end point of the study was death and the combination of death and myocardial infarction (MI). By the 9-month follow-up, there were 11 deaths (13%), 7 MIs (8%), and 16 target lesion revascularizations (19%). Death and death/MI occurred in 19% and 31%, respectively, of 59 patients with high serum levels of CRP (>3 mg/L) but in none of 24 patients with normal CRP levels (for death, P=0.02; for death/MI, P=0.006). In multivariate analysis, the highest tertiles of CRP level (P=0.028) and leukocyte count (P=0.002) were the only independent predictors of death. The highest tertiles of CRP level (P=0.002) and leukocyte count (P=0.002) and acute coronary syndromes (P=0.05) were the only independent predictors of the combined end point death/MI.

Conclusions— Elevated preprocedural levels of CRP indicate an increased risk of death and death/MI after ULMCA stenting. Inflammatory risk assessment in patients with ULMCA stenosis may be useful for selecting patients for percutaneous coronary interventions with very low risk.

Key Words: leukocytes • stents • angioplasty

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