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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Preprocedural C-reactive protein levels and cardiovascular events after coronary stent implantation
D H Walter1, S Fichtlscherer, M Sellwig
1Department of Internal Medicine IV, University of Frankfurt, Germans. D.Walter@em.uni-frankfurt.de
Insights
Elevated C-reactive protein (CRP) levels before coronary stent implantation predict worse clinical outcomes and higher restenosis rates. This inflammation marker is an independent predictor of adverse events post-procedure.
Area of Science:
- Cardiology
- Inflammation Markers
- Interventional Cardiology
Background:
- Low-grade inflammation, indicated by elevated C-reactive protein (CRP) serum levels, is linked to increased risk of recurrent coronary events.
- Understanding inflammatory markers can improve risk stratification in cardiovascular disease.
Purpose of the Study:
- To evaluate the predictive capability of preprocedural C-reactive protein (CRP) levels.
- To assess the impact of CRP on six-month clinical and angiographic outcomes following coronary stent implantation.
Main Methods:
- Prospective investigation of 276 patients undergoing coronary stent implantation.
- Analysis of preprocedural C-reactive protein (CRP) levels categorized into tertiles.
- Primary endpoint: composite of cardiac death, target vessel myocardial infarction, and repeat target vessel intervention.
Main Results:
- Higher CRP tertiles correlated with increased rates of the primary endpoint (p=0.01).
- Preprocedural CRP levels were independently associated with adverse coronary events (RR=2.0, p=0.01).
- Restenosis rates were significantly higher in upper CRP tertiles compared to the lowest (45.5% and 38.3% vs. 18.5%, p=0.002).
Conclusions:
- Elevated preprocedural C-reactive protein (CRP) is an independent predictor of adverse outcomes after coronary stent implantation.
- Systemic inflammatory activity, as measured by CRP, is associated with proliferative responses within stents.
- CRP may serve as a valuable biomarker for risk stratification in patients receiving coronary stents.
Objectives:
This study assessed the predictive value of preprocedural C-reactive protein (CRP) levels on six-month clinical and angiographic outcome in patients undergoing coronary stent implantation.
Background:
Recent data indicate that low-grade inflammation as detected by elevated CRP serum levels predicts the risk of recurrent coronary events.
Methods:
We prospectively investigated the predictive value of preprocedural CRP-levels on restenosis and six-month clinical outcome in 276 patients after coronary stent implantation. The primary combined end point was death due to cardiac causes, myocardial infarction related to the target vessel and repeat intervention of the stented vessel.
Results:
Grouping patients into tertiles according to preprocedural CRP-levels revealed that, despite identical angiographic and clinical characteristics at baseline and after stent implantation, a primary end point event occurred in 24 (26%) patients of the lowest tertile, in 42 (45.6%) of the middle tertile and in 38 (41.3%) of the highest CRP tertile, p = 0.01. On multivariate analysis, tertiles of CRP levels were independently associated with a higher risk of adverse coronary events (relative risk = 2.0 [1.1 to 3.5], tertile I vs. II and III, p = 0.01) in addition to the minimal lumen diameter after stent (p = 0.04). In addition, restenosis rates were significantly higher in the two upper tertiles compared with CRP levels in the lowest tertile (45.5% vs. 38.3% vs. 18.5%, respectively, p = 0.002).
Conclusions:
Low-grade inflammation as evidenced by elevated preprocedural serum CRP-levels is an independent predictor of adverse outcome after coronary stent implantation, suggesting that a systemically detectable inflammatory activity is associated with proliferative responses within successfully implanted stents.
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