Preprocedural plasma C-reactive protein levels, postprocedural creatine kinase-MB release, and long-term prognosis after successful coronary stenting (four-year results from the GENERATION study)

Periprocedural Myocardial Infarction

“…Patient-related factors, including multivessel disease, evidence of systemic atherosclerosis, reduced left ventricular ejection fraction, diabetes mellitus, older age, and chronic kidney disease, increase the risk of postprocedural CK-MB release by 1.3-to 1.8-fold. 9 -13 Systemic inflammation on presentation including elevated hs-C-reactive protein correlates with postprocedural CK-MB elevation, 12,14,15 as does an elevated admission white cell count (Ͼ9.5ϫ10 6 / L). 16,17 The clinical syndrome on presentation also affects risk, with enzyme negative patients with acute coronary syndromes (ACS) having up to a 40% incidence of post-PCI enzyme elevations 13 and enzyme-positive ACS patients having even more frequent and larger postprocedural MIs 18 ( Table 2).…”

Association of baseline C‐reactive protein levels with periprocedural myocardial injury in patients undergoing percutaneous bifurcation intervention: A CACTUS study subanalysis

“…Among factors affecting baseline risk, systemic inflammatory status as assessed by baseline levels of CRP, has been associated with more periprocedural complications after PCI . Six previous studies have evaluated the association of baseline CRP both with cardiac troponin and CK‐MB rise . Of these studies, five have been performed with troponin I or T as a biomarker of myocardial injury, whereas only one study assessed CK‐MB release .…”

“…Six previous studies have evaluated the association of baseline CRP both with cardiac troponin and CK‐MB rise . Of these studies, five have been performed with troponin I or T as a biomarker of myocardial injury, whereas only one study assessed CK‐MB release . However, given the complex anatomy of coronary bifurcations, data obtained in other studies could not been readily transferred to this specific type of lesions.…”

“…Moreover, studies that assessed cardiac troponin provided conflicting results with only three of five studies that assessed cardiac troponin showing a positive correlation between CRP and periprocedural myocardial infarction . Of interest, a graded association between CRP levels and the extent of myocardial necrosis was observed in some studies . In the GENERATION study, authors evaluated the association between CRP levels and CK‐MB release in patients undergoing bare metal stenting for the treatment of chronic stable angina, non–ST‐segment elevation myocardial infarction, or ST‐segment elevation myocardial infarction .…”

“…Systemic inflammation as assessed by serum levels of C‐reactive protein (CRP) has been associated with more periprocedural complications in previous studies . Furthermore, both CK‐MB and cardiac troponin elevation after PCI have been shown to correlate with preprocedural levels of CRP in previous studies performed in patients treated by balloon angioplasty or bare metal stenting . Recently, CRP has also been shown to be associated with adverse cardiac events after PCI with drug‐eluting stent (DES) implantation .…”