Prognostic impact of preprocedural C reactive protein levels on 6-month angiographic and 1-year clinical outcomes after drug-eluting stent implantation

Objective: To determine the association of preprocedural C reactive protein (CRP) levels with angiographic restenosis and adverse clinical events after drug-eluting stent (DES) implantation. Design: A prospective cohort analysis of preprocedural CRP levels as a predictor of serious ischaemic complications or binary restenosis in patients treated with DES. Setting: Tertiary referral centre. Patients: 1650 consecutive patients who underwent successful DES implantation. Patients were grouped into tertiles according to preprocedural CRP values for data analysis. Interventions: Successful DES implantation. Main outcome measures: The primary end point was a major coronary event, defined as cardiac death or Q-wave myocardial infarction. Results: Baseline clinical and angiographic characteristics were similar between the tertile groups, except that more patients had multivessel disease and acute coronary syndrome with increasing tertiles of CRP levels. At 1-year follow-up, a primary end point occurred in 4 (0.7%) patients of the lowest tertile, in 3 (0.5%) patients of the middle tertile and in 16 (2.9%) patients of the highest tertile (p = 0.003). In multivariate analysis, the highest tertile of CRP levels was an independent predictor of a major coronary event (HR 4.68, 95% CI 1.91 to 11.44, tertile III vs tertiles I and II, p = 0.001). However, restenosis rates were similar in all three groups (9.1% vs 11.4% vs 11.6%, respectively, p = 0.3). Conclusions: Preprocedural CRP levels are significantly associated with major coronary events after DES implantation. However, preprocedural CRP levels do not predict subsequent restenosis. Baseline CRP levels may be useful to guide adjunctive management for preventing serious ischaemic events in patients undergoing DES implantation.