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Background  Elevation of C‐reactive protein ( CRP ) as a marker of vascular inflammation at a late phase of drug‐eluting stent ( DES ) implantation may predict subsequent major adverse cardiac events ( MACE ).    Methods and Results  In 1234 consecutive patients undergoing  DES  implantation,  CRP  was measured both before (baseline) and 8 to 12 months after (late phase) stenting, and the relationship between elevation of  CRP  (>2.0 mg/L) and subsequent  MACE  (all cause death, nonfatal myocardial infarction, target lesion revascularization, and other additional revascularization) was assessed. As results,  CRP  was elevated in 38.0% of patients at baseline and in 23.6% during late phase ( P <0.0001), and hazard ratio ( HR ) for  MACE  was 1.52 (95% confidence interval [95%  CI ] 1.21–1.93,  P =0.0004) at baseline versus 4.00 (95%  CI  3.16–5.05,  P <0.0001) in late phase. By multivariable analysis, late‐phase  CRP  elevation ( HR  3.60, 95%  CI : 2.78–4.68,  P <0.0001), chronic kidney disease ( CKD ) ( HR  1.41, 95%  CI : 1.10–1.84,  P =0.01), and number of diseased segments ( HR  1.19, 95%  CI : 1.08–1.30,  P =0.0002) were positive predictors of  MACE , whereas statin use ( HR  0.66, 95%  CI  0.50–0.87,  P =0.003) was a negative predictor. Propensity score–matched analysis also confirmed the effect of late‐phase  CRP  on  MACE  ( HR  3.39, 95%  CI  2.52–4.56,  P <0.0001). In prediction of the late‐phase  CRP  elevation,  CKD  (odds ratio [ OR ] 1.71, 95%  CI  1.24–2.36,  P =0.001) and baseline  CRP  elevation ( OR  3.48, 95%  CI  2.55–4.74,  P <0.0001) were positive predictors, whereas newer generation  DES  ( OR  0.59, 95%  CI  0.41–0.84,  P =0.003) and statin therapy ( OR  0.68, 95%  CI  0.47–0.97,  P =0.03) were negative predictors.    Conclusions  Monitoring the late‐phase  CRP  may be helpful to identify a high‐risk subset for  MACE  among patients undergoing  DES  implantation.

journal of the american heart association

Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein