Abstract 4607: C-Reactive Protein and the Risk of Stent Thrombosis and Cardiovascular Events After Drug-Eluting Stent Implantation
Background Although C-reactive protein (CRP) has been proposed as a useful biomarker for predicting atherothrombosis, the association between CRP and stent thrombosis after drug-eluting stent (DES) implantation has not been defined.
Methods We prospectively evaluated 2691 patients treated with DES who had baseline CRP measurement between February 2003 and February 2006, with a median follow-up of 3.9 years. The associations of increased CRP levels with stent thrombosis and clinical outcomes were examined and the incremental usefulness of CRP for predicting these events beyond clinical and angiographic risk assessment was evaluated.
Results In Multivariable Cox proportional-hazards models, elevated plasma levels of CRP were significantly associated with increased risk of stent thrombosis (definite or probable; hazard ratio [HR] 3.86, 95% confidence interval [CI], 1.82–8.18; P<0.001). There were also independent associations of elevated CRP levels with late stent thrombosis (HR 3.88, 95% CI, 1.75–8.61; P<0.001). Elevated CRP levels significantly predicted the risks of death (HR 1.61, 95% CI, 1.13–2.28; P=0.008), myocardial infarction (MI) (HR 1.63, 95% CI, 1.25–2.12; P=0.001), and death or MI (HR 1.61, 95% CI, 1.29–2.00; P<0.001), but not target-vessel revascularization (HR 1.20, 95% CI, 0.90–1.61; P=0.21). The incorporation of CRP into a model with patient, lesion, and procedural factors resulted in significant increase of C statistic for the prediction of stent thrombosis, MI, and composite of death or MI.
Conclusions Elevated CRP levels were significantly associated with increased risks of stent thrombosis, death and MI in patients receiving DES. Inflammatory risk assessment using CRP as an adjunct to clinical and angiographic risk factors may be useful for identification of high-risk patients.