Abstract 4752: Does Pre-procedural C-reactive Protein Level Carry an Adverse Cardiovascular Prognosis After Drug-eluting Stent Implantation?
Background: High pre-procedural C-reactive protein (CRP) carries an adverse cardiovascular prognosis after bare metal stent implantation. There are few data about the predictive value of pre-procedural CRP after drug-eluting stent (DES) implantation. This study was designed to address whether the same applies after DES placement.
Methods: After exclusion of patients with an acute coronary syndrome and troponin I elevation, we analyzed 936 consecutive patients who had DES implantation and a pre-procedure CRP measurement from 2003 to 2007. Patients were divided into tertiles according to pre-procedural CRP levels (<1.31, 1.31–3.76, and >3.76 mg/L). The primary endpoint was the composite of death or nonfatal Q-wave myocardial infarction (death/MI) at 2 years. Target vessel revascularization (TVR) was also assessed.
Results: No statistical difference among CRP tertiles was found at 6 months and 1 year for death/MI, respectively, 1.3% vs. 2.6% vs. 1.6% (p=0.5) and 1.6% vs. 2.9% vs. 4.2% (p=0.2). At 2 years, death/MI occurred in 8 (2.6%) patients in the lowest, 16 (5.2%) in the middle, and 26 (8.5%) in the highest tertile (p=0.006). TVR was similar in the 3 groups, respectively, 13.2% vs.14.9% vs.16.9%, (p=0.5). On multivariate analysis the upper tertile of CRP was an independent predictor of 2-year death/MI with a hazard ratio of 2.8. (Table⇓)
Conclusion: High pre-procedural CRP levels remain associated with risk of death and MI after DES implantation, but are not related to TVR at 2 years. Thus, an elevated CRP in the PCI population appears to be more a marker of global cardiovascular risk than a predictor of post-DES related complication.