Clinical chemistry · 2004
Preprocedural C-reactive protein is not associated with angiographic restenosis or target lesion revascularization after coronary artery stent placement.
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Rittersma Saskia Z H, de Winter Robbert J, Koch Karel T, Schotborgh Carl E, Bax Matthijs, Heyde Gerlind S, van Straalen Jan P, Mulder Karla J, Tijssen Jan G P, Sanders Gerard T, Piek Jan J
Аннотация
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 > or = 50% of vessel diameter) rate was 19% in patients with CRP values within the reference interval (< or = 3 mg/L) and 22% in patients with CRP >3 mg/L [odds ratio (OR) = 1.2; 95% confidence interval (CI), 0.73-2.09]. Statin 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.
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 > or = 50% of vessel diameter) rate was 19% in patients with CRP values within the reference interval (< or = 3 mg/L) and 22% in patients with CRP >3 mg/L [odds ratio (OR) = 1.2; 95% confidence interval (CI), 0.73-2.09]. Statin 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.
Предметные рубрики MeSH
Angioplasty, Balloon, CoronaryAnticholesteremic AgentsC-Reactive ProteinCohort StudiesCoronary AngiographyCoronary Artery DiseaseCoronary RestenosisFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsLogistic ModelsMaleMiddle AgedMultivariate AnalysisPredictive Value of TestsProspective StudiesStents