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Published on: January 28, 2020
Elevated preprocedural high-sensitivity C-reactive protein levels are associated with neointimal hyperplasia and
Young Joon Hong1, Myung Ho Jeong, Sang Yup Lim
1The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
Insights
Elevated high-sensitivity C-reactive protein (hs-CRP) predicts restenosis after coronary stenting. Statin therapy significantly reduces this restenosis risk in patients with elevated hs-CRP levels.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Elevated high-sensitivity C-reactive protein (hs-CRP) is linked to recurrent coronary events.
- Statin therapy is known to reduce coronary event risk.
Purpose of the Study:
- To assess the relationship between pre-procedural hs-CRP levels and in-stent neointimal hyperplasia (NIH) after coronary stenting.
- To evaluate the effect of statins on restenosis in patients with varying hs-CRP levels.
Main Methods:
- 100 patients undergoing stent implantation were divided into normal (<0.5 mg/dl) and elevated (>=0.5 mg/dl) hs-CRP groups.
- Angiographic and intravascular ultrasound follow-up was performed at 6 months.
- Correlation between hs-CRP and NIH area was analyzed, along with statin effects on restenosis.
Main Results:
- A significantly larger NIH cross-sectional area was observed in the elevated hs-CRP group compared to the normal hs-CRP group (p=0.001).
- A positive correlation was found between pre-interventional hs-CRP level and NIH area (r=0.52, p<0.001).
- Statin therapy significantly reduced restenosis rates (20% vs 37.5%, p=0.031) and neointimal area in patients with elevated hs-CRP, but not in those with normal hs-CRP.
Conclusions:
- Pre-procedural hs-CRP levels can help predict restenosis after coronary stenting.
- Statin therapy is effective in reducing restenosis rates in patients with elevated hs-CRP levels.
Background:
Recent data indicate that an elevated serum level of high-sensitivity C-reactive protein (hs-CRP) predicts the risk of recurrent coronary events, and that statin therapy decreases the risk of coronary events. This study assessed the relationship between the pre-procedural hs-CRP level and in-stent neointimal hyperplasia (NIH) after stenting and the effects of statins on the relationship between restenosis after stenting and the serum hs-CRP levels of patients with coronary artery disease.
Methods And Results:
This study included 100 patients who underwent stent implantation for angiographically significant stenosis. Patients were divided into a normal C-reactive protein (CRP) group (<0.5 mg/dl, n=59) and elevated CRP group (>or=0.5 mg/dl, n=41). All patients underwent angiographic and intravascular ultrasound follow-up at 6 months. The baseline CRP level was 0.29+/-0.08 mg/dl in the normal CRP group and 2.90+/-2.31 mg/dl in the elevated CRP group. The NIH cross-sectional area (CSA) in the minimal lumen CSA at follow-up was significantly larger in the elevated CRP group compared with the normal CRP group (1.9+/-1.3 mm2 vs 3.0+/-1.5 mm2, p=0.001). A significant positive correlation was found between pre-interventional CRP level and NIH area (r=0.52, p<0.001). In patients with normal CRP, an association between statin therapy and restenosis was not observed. However, when the analysis was confined to patients with elevated CRP, statin therapy significantly reduced the restenosis rate (20% vs 37.5%, p=0.031). In the normal CRP group, the intra-stent neointimal area at 6 months was not different between the non-statin and statin groups (2.2+/-1.4 mm2 vs 1.8+/-1.1 mm2). However, in the elevated CRP group, statin therapy significantly decreased the neointimal area at 6-month follow-up (3.6+/-1.7 mm2 vs 2.4+/-1.3 mm2, p<0.001).
Conclusion:
Measuring the pre-interventional hs-CRP level may help predict the development of restenosis after stenting and statin therapy will significantly reduce the restenosis rate in patients with an elevated hs-CRP.
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