Association between C-Reactive protein levels and subsequent cardiac events among patients with stable angina treated with coronary artery stenting - 28/08/11

Doi : 10.1016/S0002-9343(03)00183-9

Alban Dibra, MD ^a, Julinda Mehilli, MD ^a, Siegmund Braun, MD ^b, Martin Hadamitzky, MD ^a, Hannsjörg Baum, MD ^c, Josef Dirschinger, MD ^a, Helmut Schühlen, MD ^a, Albert Schömig, MD ^a, Adnan Kastrati, MD ^a,^⁎
^a Deutsches Herzzentrum and Medizinische Klinik rechts der Isar (AD, JM, MH, JD, HS, AS, AK), Technische Universität Mn̈chen, Munich, Germany
^b Institut für Laboratoriumsmedizin, Deutsches Herzzentrum (SB), Technische Universität Mn̈chen, Munich, Germany
^c Institut für Klinische Chemie und Pathochemie (HB); Technische Universität Mn̈chen, Munich, Germany

^*Requests for reprints should be addressed to Adnan Kastrati, MD, Deutsches Herzzentrum München, Lazarettstrasse 36, 80636 Munich, Germany

Abstract

Purpose

To investigate the prognostic value of elevated C-reactive protein levels in patients with stable angina who underwent coronary stenting.

Methods

We followed a consecutive series of 1152 patients with stable angina who had undergone coronary stenting. We measured baseline C-reactive protein levels before stenting with a high-sensitivity assay; 651 patients (57%) had elevated C-reactive protein levels (>5 mg/L). The primary endpoint was either death or myocardial infarction within 1 year after the procedure. Angiographic restenosis was defined as a ≥50% diameter stenosis at follow-up angiography.

Results

During the 1-year follow-up, 62 (9.5%) of the 651 patients with an elevated C-reactive protein level and 24 (4.8%) of the 501 patients with normal levels died or had a myocardial infarction (P = 0.002). In a multivariate analysis, elevated baseline C-reactive protein levels were associated with almost a twofold increase in the rate of death or myocardial infarction after coronary stenting (hazard ratio = 1.8; 95% confidence interval: 1.1 to 2.9). Most of the difference in the event rates developed within the first 30 days. Baseline C-reactive protein levels did not correlate with restenosis.

Conclusion

Elevated preprocedural C-reactive protein levels are associated with a less favorable prognosis in patients with stable angina who undergo coronary stenting. The measurement of C-reactive protein levels in these patients may help to identify those who may benefit from a treatment strategy aimed at the attenuation of inflammation.

El texto completo de este artículo está disponible en PDF.

Keywords : Coronary disease, inflammation, restenosis, stents, thrombosis