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Usefulness of Preprocedure High-Sensitivity C-Reactive Protein to Predict Death, Recurrent Myocardial Infarction, and Stent Thrombosis According to Stent Type in Patients With ST-Segment Elevation Myocardial Infarction Randomized to Bare Metal or Drug-Eluting Stenting During Primary Percutaneous Coronary Intervention
- Source :
-
American Journal of Cardiology . Jun2011, Vol. 107 Issue 11, p1597-1603. 7p. - Publication Year :
- 2011
-
Abstract
- It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome depending on implanted stent type. We investigated the prognostic value of hs-CRP in relation to type of stent implanted in patients with ST-segment elevation myocardial infarction (STEMI). Immediately before primary percutaneous coronary intervention (pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent [BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95% confidence interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2 mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently predicted the composite end point of death and MI at 36-month follow-up. There was a significant interaction (p = 0.006) for hs-CRP and stent type. Survival analysis demonstrated significant differences for occurrence of death and MI: 4.8% in BMS + CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS + CRP ≤2 mg/L. In conclusion, preprocedure hs-CRP predicts outcome after pPCI in patients with STEMI. Our hypothesis-generating data indicate that BMS implantation should be preferred when hs-CRP is ≤2 mg/L and DES when hs-CRP is >2 mg/L to decrease long-term adverse outcomes including stent thrombosis in patients with STEMI treated with pPCI. These findings need confirmation in larger randomized clinical trials. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00029149
- Volume :
- 107
- Issue :
- 11
- Database :
- Academic Search Index
- Journal :
- American Journal of Cardiology
- Publication Type :
- Academic Journal
- Accession number :
- 60664691
- Full Text :
- https://doi.org/10.1016/j.amjcard.2011.01.042