Abstract 14099: Prognostic Values of C-Reactive Protein Levels on Clinical Outcome After Endovascular Therapy in Hemodialysis Patients with Peripheral Artery Disease
Background: Endovascular therapy (EVT) has been widely performed for peripheral artery disease. However, the high restenosis rate after EVT remains a major problem in patients on hemodialysis. Recent studies suggest that C-reactive protein (CRP) reflects vascular wall inflammation and can predict adverse events. We evaluated the possible prognostic values of CRP on outcomes in hemodialysis patients undergoing EVT.
Methods: A total of 234 hemodialysis patients undergoing EVT for peripheral artery disease were enrolled and were followed-up for up to 5 years. They were divided into tertiles according to serum CRP levels (the lowest tertile: < 1.4 mg/l, the middle tertile: 1.4 – 6.0 mg/l, and the highest tertile: ≥ 6.0 mg/l). We analyzed the incidence of major adverse cardiovascular events (MACE) as a composite endpoint including all-cause death, target lesion revascularization (TLR) after EVT, and amputation.
Results: No differences were seen in age, sex, prevalence of diabetes, dyslipidemia, and smoking status, past history of coronary artery disease and stroke, ankle brachial pressure index, and lesion characteristics among the three groups. Clinical follow-up data were obtained from all patients. During follow-up period (33 ± 21), ten (12.8%) patients in the lowest tertile, 17 (21.8%) in the middle tertile and 26 (33.3%) in the highest tertile died (P = 0.0090). Kaplan-Meier analysis showed that the event-free survival rate from MACE for 5 years was 60.2%, 50.0%, and 25.1% in the T1, T2 and T3, respectively (p<0.0001). In addition, freedom rate from TLR was 72.5%, 64.1% and 44.5% (p=0.0014), and all-cause survival rate was 81.5%, 65.2% and 59.3% in the T1, T2 and T3, respectively (p=0.0078). However, the difference of limb salvage rate was not significant (88.7%, 77.3% and 74.8% in T1, T2 and T3, respectively, p=0.15). Even after adjusting for other risk factors at baseline, pre-procedural CRP levels were a significant predictive factor for MACE after EVT in a multivariable Cox analysis (HR 1.01, 95%CI:1.00–1.02, P < 0.0001).
Conclusions: Elevated pre-procedural serum CRP levels were associated with MACE, TLR, and any-cause death after EVT in hemodialysis patients with peripheral artery disease.
- © 2010 by American Heart Association, Inc.