Preprocedural Levels of C-Reactive Protein and Leukocyte Counts Predict 9-Month Mortality After Coronary Angioplasty for the Treatment of Unprotected Left Main Coronary Artery Stenosis

Abstract

Background-An accurate preprocedural risk stratification scheme for patients with unprotected left main coronary artery (ULMCA) stenosis who are undergoing coronary stenting is lacking. We examined the predictive value of preprocedural levels of C-reactive protein (CRP), fibrinogen, and leukocyte counts with respect to 9-month clinical outcomes after stenting of the ULMCA stenosis. Methods and Results-Levels of CRP, fibrinogen, and leukocyte count were prospectively measured in 83 patients undergoing stenting of the ULMCA. A drug-eluting stent was used in 42 patients, and a bare metal stent was used in 41. The end point of the study was death and the combination of death and myocardial infarction (MI). By the 9-month follow-up, there were 11 deaths (13%), 7 MIs (8%), and 16 target lesion revascularizations (19%). Death and death/MI occurred in 19% and 31%, respectively, of 59 patients with high serum levels of CRP (Ͼ3 mg/L) but in none of 24 patients with normal CRP levels (for death, Pϭ0.02; for death/MI, Pϭ0.006). In multivariate analysis, the highest tertiles of CRP level (Pϭ0.028) and leukocyte count (Pϭ0.002) were the only independent predictors of death. The highest tertiles of CRP level (Pϭ0.002) and leukocyte count (Pϭ0.002) and acute coronary syndromes (Pϭ0.05) were the only independent predictors of the combined end point death/MI. Conclusions-Elevated preprocedural levels of CRP indicate an increased risk of death and death/MI after ULMCA stenting. Inflammatory risk assessment in patients with ULMCA stenosis may be useful for selecting patients for percutaneous coronary interventions with very low risk.

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

“…Recent observational studies suggested that periprocedural CRP levels might be a risk indicator for clinical outcomes after DES implantation. 20,21 However, these studies were hampered by small patient numbers, limited durations of follow-up, or a retrospective observational study design. The present study highlights the prognostic value and clinical usefulness of CRP among patients treated with DES in several important respects.…”

Comparison of Drug-Eluting Stent With Bare Metal Stent for Distal De Novo Unprotected Left Main Coronary Artery Stenosis - A Propensity Score-Matched Cohort Study -

“…40-42 Furthermore, one study has shown that the serum level of high-sensitivity C-reactive protein may independently predict 9-month mortality following after PCI for ULMCA stenosis. 43 Therefore, the association between TLR and significant HF needs to be verified in a large-scale study.…”

Inflammation in Atherosclerosis

“…Although vascular trauma from PCI denudes endothelium and initiates vascular wound healing with early inflammation and smooth muscle cell proliferation, there is generally a reduction in systemic markers of inflammation after PCI. 19 Genetic analyses suggest markers for increased risk of restenosis. The improved blood flow and reduced stasis at sites where stenosis is removed also may reduce the intense inflammation seen in unstable plaque before intervention, but this remains speculative.…”