Preprocedural C-reactive protein is not associated with angiographic restenosis or target lesion revascularization after coronary artery stent placement

摘要

Background: We assessed the Predictive value of preprocedural plasma C-reactive protein (CRP) concentrations and statin therapy on 6 months angiographic and 1-year clinical outcome after nonurgent coronary stent placement. Methods and Results: Baseline plasma high-sensitivity CRP concentrations were prospectively measured in 345 patients undergoing elective stent placement in a native coronary artery. The binary angiographic in-stent restenosis (ISR; stenosis = greater than or equal to50% of vessel diameter) rate was 19% in Patients with CRP values within the reference interval (less than or equal to3 mg/L) and 22% in patients with CRP >3 mg/L [odds ratio (OR) 1.2; 95% confidence interval (CI), 0.73-2.09]. Stalin therapy in a univariate analysis significantly reduced both angiographic and clinical ISR rates. Multivariate logistic regression analysis identified unstable angina, smoking, and stent length, but neither CRP concentration nor statin therapy as independent predictors for angiographic ISR. Patients with an abnormal CRP value showed a trend toward a higher risk of nonfatal myocardial infarction (3.8% vs 0.5%; OR = 7.43; 95% CI, 0.87-61.65). Target lesion revascularization rates did not differ between the two groups (9.6% vs 10.6%; OR = 1.13; 95% CI, 0.56-2.28). In multivariate analysis, male sex (OR 0.44, 95% CI, 0.19-0.97) and statin therapy (OR 0.26; 95% CI, 0.09-0.68) were independent predictors for the occurrence of target lesion revascularization. Conclusions: This study demonstrated a lack of association between preprocedural plasma CRP concentrations and angiographic coronary ISR or clinically driven target lesion revascularization. Patients with an abnormal CRP concentration showed a trend toward higher risk of nonfatal myocardial infarction during 1 year of follow-up. Statin therapy was independently associated With decreased clinically driven target lesion revascularization, underlining the beneficial effects of statins on clinical outcome. (C) 2004 American Association for Clinical Chemistry