Influence of Late Vascular Inflammation on Long-Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C-Reactive Protein

Abstract

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.