Open AccessInfluence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
Author(s) -
Shiba Masanori,
Itaya Hideki,
Iijima Raisuke,
Nakamura Masato
Publication year - 2016
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.116.003354
Subject(s) - mace , medicine , hazard ratio , c reactive protein , cardiology , myocardial infarction , odds ratio , confidence interval , percutaneous coronary intervention , surgery , inflammation
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.