Preprocedural C-Reactive Protein Is Not Associated with Angiographic Restenosis or Target Lesion Revascularization after Coronary Artery Stent Placement

Rittersma, Saskia Z.H.; Winter, Robbert J. de; Koch, Karel T.; Schotborgh, Carl E.; Bax, Matthijs; Heyde, G.; Straalen, Jan P. van; Mulder, K.; Tijssen, Jan G.P.; Sanders, Gerard T.; Piek, Jan J.

doi:10.1373/clinchem.2004.032656

Cited by 40 publications

(25 citation statements)

References 33 publications

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“…We previously showed that stent placement in humans is followed by abundant cellular infiltration around the metal stent struts (22 ), indicating a local inflammatory response. Our present results on systemic indicators of inflammation were all negative, although they were in accordance with our previous negative results for C-reactive protein as a prognostic marker for angiographic ISR (23 ). To our knowledge, our study is the first attempt to associate individual differences in cytokine production with angiographic outcome in a large cohort of patients, all treated electively with the same coronary stents.…”

Section: Discussionsupporting

confidence: 92%

Relationship between In Vitro Lipopolysaccharide-Induced Cytokine Response in Whole Blood, Angiographic In-Stent Restenosis, and Toll-Like Receptor 4 Gene Polymorphisms

Rittersma¹,

Hovinga

Koch³

et al. 2005

Clinical Chemistry

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Background: In coronary in-stent restenosis (ISR), a substantial contribution of inflammation is assumed.We evaluated the association between polymorphisms in the Toll-like receptor 4 (TLR4) gene and cytokine response after lipopolysaccharide (LPS) challenge and the development of ISR. Methods: Patients were included after successful elective stent placement in a native coronary artery and were scheduled for follow-up angiography after 6 months. Quantitative coronary analysis was performed off-line. Patient whole blood was challenged with LPS for 24 h. Baseline and stimulated concentrations of interleukin (IL)-1␤, IL-6, tumor necrosis factor-␣, and IL-10 were assessed by ELISA. Two cosegregating single-nucleotide polymorphisms in the TLR4 gene (Asp299Gly and Thr399Ile) were analyzed by allele-specific PCR amplification of genomic DNA. Results: A total of 236 consecutive patients were included, and 40 (17%) developed ISR. Median baseline and stimulated cytokine concentrations did not differ between patients with and without ISR. In multivariate analysis, male sex, unstable angina, hypertension, and chronic total occlusion were predictors of ISR. TLR4 genotypes were not associated with baseline or stimulated cytokine concentrations or with angiographic variables at follow-up.

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Section: Discussionsupporting

confidence: 92%

Relationship between In Vitro Lipopolysaccharide-Induced Cytokine Response in Whole Blood, Angiographic In-Stent Restenosis, and Toll-Like Receptor 4 Gene Polymorphisms

Rittersma¹,

Hovinga

Koch³

et al. 2005

Clinical Chemistry

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“…The specific prognostic role of CRP in predicting restenosis in patients with acute coronary syndromes, who supposedly have more inflamed and unstable plaques and arteries, was not assessed in this study. However, the same group has recently published a large study confirming the predictive role of CRP on the risk of death and myocardial infarction after PCI (22 ), and their current study (4 ), notwithstanding the low-risk population and relatively small number of patients, has shown a trend in this direction. Because the data in favor of the predictive role of CRP for death and myocardial infarction are very consistent, patients undergoing PCI should not be denied a CRP measurement.…”

supporting

confidence: 56%

“…Indeed, the low risk was confirmed by the low rate of death or myocardial infarction 12 months after stenting, which was only 1.7% in the overall cohort. Moreover, the statistical power of this patient cohort to recognize predictive variables for restenosis may have been suboptimal, as evidenced by the surprising fact that a well-recognized and independent predictor of restenosis, such as diabetes mellitus (5 ), was not associated with either restenosis or target lesion revascularization in this study (4 ).…”

mentioning

confidence: 79%

Preprocedural C-Reactive Protein for Risk Prediction Before Percutaneous Coronary Intervention (PCI): A European Perspective

Biasucci

Biondi‐Zoccai

2004

Clinical Chemistry

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“…These results were consistent with previous studies reporting the lack of an association between CRP and repeat revascularization after bare metal stent treatment. 34,35 …”

Section: Discussionmentioning

confidence: 99%

C-Reactive Protein and the Risk of Stent Thrombosis and Cardiovascular Events After Drug-Eluting Stent Implantation

Park

Yun²,

Lee³

et al. 2009

Circulation

105

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Background-Although C-reactive protein (CRP) has been proposed as a useful biomarker for predicting atherothrombosis, the association between CRP and stent thrombosis after drug-eluting stent implantation has not been defined. Methods and Results-We prospectively evaluated 2691 patients treated with drug-eluting stents who had a baseline CRP measurement. The primary outcome was stent thrombosis; secondary outcomes were death, myocardial infarction (MI), death or MI, and target vessel revascularization. During follow-up (median, 3.9 years), 32 patients had definite or probable stent thrombosis, 137 patients died, 227 had an MI, and 195 underwent target vessel revascularization. In multivariable Cox proportional-hazards models, elevated levels of CRP were significantly associated with increased risk of stent thrombosis (hazard ratio, 3.86; 95% confidence interval, 1.82 to 8.18; PϽ0.001). Elevated CRP levels also significantly predicted the risks of death (hazard ratio, 1.61; 95% confidence interval, 1.13 to 2.28; Pϭ0.008), MI (hazard ratio, 1.63; 95% confidence interval, 1.25 to 2.12; Pϭ0.001), and death or MI (hazard ratio, 1.61; 95% confidence interval, 1.29 to 2.00; PϽ0.001) but not target vessel revascularization (hazard ratio, 1.20; 95% confidence interval, 0.90 to 1.61; Pϭ0.21). The incorporation of CRP into a model with patient, lesion, and procedural factors resulted in a significant increase in the C statistic for the prediction of stent thrombosis, MI, and the composite of death or MI. Conclusions-Elevated CRP levels were significantly associated with increased risks of stent thrombosis, death, and MI in patients receiving drug-eluting stents, suggesting the usefulness of inflammatory risk assessment with CRP. Given the relatively infrequent occurrence of stent thrombosis, death, and MI, larger studies with longer-term follow-up are required to confirm the novel relationship.

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Preprocedural C-Reactive Protein Is Not Associated with Angiographic Restenosis or Target Lesion Revascularization after Coronary Artery Stent Placement

Abstract: Background:We assessed the predictive value of preprocedural plasma C-reactive protein (CRP) concentrations and statin therapy on 6 months angiographic and 1-year clinical outcome after nonurgent coronary stent placement. Methods and Results

Cited by 40 publications

References 33 publications

Relationship between In Vitro Lipopolysaccharide-Induced Cytokine Response in Whole Blood, Angiographic In-Stent Restenosis, and Toll-Like Receptor 4 Gene Polymorphisms

Relationship between In Vitro Lipopolysaccharide-Induced Cytokine Response in Whole Blood, Angiographic In-Stent Restenosis, and Toll-Like Receptor 4 Gene Polymorphisms

Preprocedural C-Reactive Protein for Risk Prediction Before Percutaneous Coronary Intervention (PCI): A European Perspective

C-Reactive Protein and the Risk of Stent Thrombosis and Cardiovascular Events After Drug-Eluting Stent Implantation

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