C-reactive protein (CRP) elevation is associated with an adverse cardiovascular prognosis
after bare metal stent implantation. Data have suggested a similar association between
preprocedural CRP and adverse events after drug-eluting stent (DES) implantation.
The present study was designed to address whether such a relation exists after DES
placement. After excluding patients presenting with an acute coronary syndrome with
troponin I elevation, we analyzed the data from 936 consecutive patients who had undergone
DES implantation from 2003 to 2007 and had a preprocedural CRP measurement. The patients
were divided into 3 groups according to the preprocedural CRP level (<1.31, 1.31-3.76,
and >3.76 mg/L). The primary end point was the composite of death and Q-wave myocardial
infarction (QWMI) at 2 years of follow-up. Target vessel revascularization was also
assessed. The rate of death/QWMI was not significantly different statistically among
the CRP tertiles during the in-hospital period (0.6% vs 0.0% vs 0.6%, p = 0.5) or
at 1 year of follow-up (1.9% vs 2.9% vs 4.5%, p = 0.2). At 2 years, death/QWMI had
occurred in 2.9% of patients in the lowest, 5.2% in the middle, and 8.8% in the highest
tertile (p = 0.006). The incidence of target vessel revascularization was similar
in the 3 groups at 2 years of follow-up (13.2% vs 14.9% vs 16.9%, p = 0.5). On multivariate
analysis, the upper tertile of CRP was an independent predictor of death/QWMI at 2
years (hazard ratio 2.5, 95% confidence interval 1.1 to 5.4, tertile 3 vs tertile
1, p = 0.006). In conclusion, high preprocedural CRP levels are associated with an
increased risk of death and QWMI after DES implantation at long-term follow-up but
not acutely. The CRP levels were not related to target vessel revascularization. Thus,
an elevated CRP level in this population appears to be more of a marker of global
cardiovascular risk than a predictor of post-DES-related complications.
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