Abstract 6012: Prognostic Impact of Preprocedural Levels of C-Reactive Protein on Stent Thrombosis after Coronary Stent Implantation
Background : Stent thrombosis (ST) is the most concerning adverse outcome of coronary stent placement, frequently presenting as acute myocardial infarction or death. Although the safety concerns regarding ST have been raised, the accurate risk prediction and stratification for these events after percutaneous coronary intervention (PCI) still remain challenging. Inflammatory mechanisms may play a crucial role in the stent thrombosis. C-reactive protein (CRP), a marker of systemic inflammation, has been consistently associated with an increased risk of cardiovascular events. We therefore evaluated whether elevated preinterventional CRP levels were related to an increased risk of ST after stent implantation.
Methods : We studied 2,516 consecutive patients (mean age 68.9±10.7yrs) who underwent successful stent implantation. Blood samples were taken before PCI to evaluate baseline CRP. The subjects were divided into two groups of elevated CRP group (group E) and non-elevated CRP group (group N) according to the median value of baseline CRP for data analysis. The primary end point of the study was definite ST. The secondary end point was defined as cardiac death due to ST.
Results : The median value of baseline CRP was 2.09mg/L in all patients. During the 2 year follow-up, definite ST was observed in 29 cases (1.15%) and ST related death was seen in 11 cases (0.44%). There was no significant difference of ST rate between bare metal stent cases and drug eluting stent cases. Patients of group E (n=1,260) with higher serum levels of CRP (≥2.09 mg/L) had a significantly higher incidence of stent thrombosis, as compared to those of group N (n=1,256) with lower serum levels of CRP (1.83% vs. 0.48%, p=0.0015). Also, the rate of death after ST of group E was significantly higher than those of group N (0.71% vs. 0.16%, p=0.0349).
Conclusions : Elevated preprocedural levels of CRP were significantly associated with the development of ST and ST related death. Baseline CRP levels may be useful to predict clinical risk of ST in patients treated with coronary stents.