Abstract
Background: Inflammation is an important feature of arteriosclerotic disease, and the vulnerability of coronary plaques in acute myocardial infarction (AMI) may be related to the levels of serum C‐reactive proteins (CRP). While some risk factors for early and late complications have been suggested, an accurate and definitive preprocedural risk stratiFICAtion of patients undergoing percutaneous transluminal coronary an‐gioplasty (PTCA) is still lacking.
Hypothesis: The study was undertaken to investigate whether early and late complications after PTCA could be predicted by evaluation of baseline serum CRP levels in patients with AMI.
Methods: Levels of serum CRP were measured in a total of 230 patients with AMI undergoing PTCA and provisional stent. They were divided into two groups: Group 1 (n = 48) with elevated CRP levels (≥5 mg/l) and Group 2 (n = 182) with normal CRP levels (< 5 mg/l).
Results: There were no signiFICAnt differences in baseline clinical, angiographic, and procedural characteristics between the two groups. However, the incidence of in‐hospital adverse coronary events (reinfarction, coronary reocclusion, target vessel revascularization, and death) and severe left ventricular dysfunction was signiFICAntly higher in Group 1 (18.3 vs. 6.1%, p < 0.05 and 20.9 vs. 6.1%, p < 0.05, respectively). In addition, bailout stenting was performed more frequently in Group 1 than in Group 2 (60.4 vs. 36.3%, p < 0.005). No signiFICAnt late complications were noted. The serum levels of CRP were the only independent predictors of early adverse events.
Conclusions: Preprocedural serum CRP level might be considered a powerful predictor of early but not late complications in patients undergoing PTCA/stent procedures.
Keywords: inflammation, C‐reactive protein, coronary artery disease, percutaneous transluminal coronary angioplasty/stent, major adverse cardiac events, left ventricular ejection fraction, restenosis
Full Text
The Full Text of this article is available as a PDF (48.1 KB).
References
- 1. Stone GW, Brodie BR, Griffin JJ, for the PAMI Stent Pilot Trial Investigators : Clinical and angiographic follow‐up after primary stenting in acute myocardial infarction. The Primary Angiography in Myocardial Infarction (PAMI) Stent Pilot Trial. Circulation 1999; 99: 1548–1554 [DOI] [PubMed] [Google Scholar]
- 2. Ross R: The pathogenesis of atherosclerosis: A perspective for the 1990s. Nature 1993; 362: 801–809 [DOI] [PubMed] [Google Scholar]
- 3. Baumann H, Gauldie J: Regulation of hepatic acute phase plasma protein genes by hepatocyte stimulating factors and other mediators of inflammation. Mol Biol Med 1990; 7: 147–159 [PubMed] [Google Scholar]
- 4. Abdelmouttaleb I, Danchin N, Ilardo C: C‐reactive protein and coronary artery disease: Additional evidence of the implication of an inflammatory process in acute coronary syndrome. Am Heart J 1999; 137: 346–351 [DOI] [PubMed] [Google Scholar]
- 5. Liuzzo G, Biasucci LM, Gallimore JR: Prognostic value of C‐reactive protein and plasma amyloid A protein in severe unstable angina. N Engl J Med 1994; 331: 417–424 [DOI] [PubMed] [Google Scholar]
- 6. Macaya C, Serruys PW, Ruygrok P: Continued benefit of coronary stenting versus balloon angioplasty: One‐year clinical follow‐up of Benestent trial. Benestent Study Group. J Am Coll Cardiol 1996; 27: 255–261 [DOI] [PubMed] [Google Scholar]
- 7. Detre KM, Holmes DR Jr, Holubkov R: Incidence and consequences of periprocedural occlusion of the 1985–1986 National Heart, Lung, and Blood Institute's Percutaneous Transluminal Coronary Angioplasty registry. Circulation 1990; 82: 739–750 [DOI] [PubMed] [Google Scholar]
- 8. de Feyer PJ, Ruygrok PN: Coronary intervention: Risk stratiFICAtion and management of abrupt coronary occlusion. Eur Heart J 1995; 16 (suppl L): L97–103 [DOI] [PubMed] [Google Scholar]
- 9. Oltrona L, Eisenberg PR, Lasala JM, Sewall DJ, Shelton ME, Winters KJ: Association of heparin resistant thrombin activity and acute ischemic complications of coronary interventions. Circulation 1996; 94: 2064–2071 [DOI] [PubMed] [Google Scholar]
- 10. Tschoepe D, Schultheiss HB, Kolarov P: Platelet membrane activation markers are predictive for increased risk of acute ischemic events after PTCA. Circulation 1993; 88: 37–42 [DOI] [PubMed] [Google Scholar]
- 11. Rensing BJ, Hermans WRM, Vos J: Luminal narrowing after percutaneous coronary angioplasty: A study of clinical, procedural, and lesional factors related to long‐term angiographic outcome. Circulation 1993; 88: 975–985 [DOI] [PubMed] [Google Scholar]
- 12. Ishiwata S, Tukada R, Nakanishi S, Nishiyama S, Seki A: Postangioplasty restenosis: Platelet activation and the coagulation‐fibrinolysis system as possible factors in the pathogenesis of restenosis. Am Heart J 1997; 133: 387–392 [DOI] [PubMed] [Google Scholar]
- 13. Pietersma A, Kofflard M, de Wit EA: Late luminal loss after coronary angioplasty is associated with the activation status of circulating phagocytes before treatment. Circulation 1995; 91: 1320–1325 [DOI] [PubMed] [Google Scholar]
- 14. Montalescot G, Ankri A, Vicaut E, Drobinski G, Grosgogeat Y, Thomas D: Fibrinogen after coronary angioplasty as a risk factor for restenosis. Circulation 1995; 92: 31–38 [DOI] [PubMed] [Google Scholar]
- 15. Desmarais RL, Sarembock IJ, Ayers CR, Vernon SM, Powers ER, Gimple LW: Elevated serum lipoprotein(a) is a risk factor for clinical recurrence after coronary balloon angioplasty. Circulation 1995; 91: 1403–1409 [DOI] [PubMed] [Google Scholar]
- 16. Tan K, Sulke N, Sowton E: Clinical and lesion morphologic determinants of coronary angioplasty success and complications: Current experience. J Am Coll Cardiol 1995; 25: 855–865 [DOI] [PubMed] [Google Scholar]
- 17. Cermak J, Key NS, Bach RR, Balla J, Jacob HS Vercellotti GM: C‐reactive protein induces human peripheral blood monocytes to synthesize tissue factor. Blood 1993; 82: 513–520 [PubMed] [Google Scholar]
- 18. Galis ZS, Muszynski M, Sukhova GK, Simon‐Morrissey E, Lippy P: Enhanced expression of vascular matrix metalloproteinases induced in vitro by cytokines and in regions of human atherosclerotic lesions. Ann NY Acad Sci 1995; 748: 501–507 [DOI] [PubMed] [Google Scholar]
- 19. Wilkins J, Gallimore JR, Tennent GA: Rapid automated enzyme immunoassay of serum amyloid A. Clin Chem 1994; 40: 1284–1290 [PubMed] [Google Scholar]
- 20. Centers for Disease Control and Prevention : Plan and operation of the Third National Health and Nutrition Examination Survey. 1988–94. Bethesda, Md.: National Center for Health Statistics; 1994. Vital Health Statistics 1(32). Series 1, No. 32 [Google Scholar]
- 21. Abbot Laboratories Instruction Manual. Protein C‐reactive TDx/TDxFLx. Abbot Laboratories, North Chicago, Ill.
- 22. Shine B, De Beer FC, Pepys MB: Solid phase radioimmunoassay for CRP. Clin Chim Acta 1981; 117: 13–23 [DOI] [PubMed] [Google Scholar]
- 23. Austen WG, Eduards JE, Frye RL: A reporting system on patients evaluated for coronary artery disease. Circulation 1975; 51: 7–40 [DOI] [PubMed] [Google Scholar]
- 24. Rentrop KP, Cohen M, Bianke H: Changes in collateral channel filling immediately after controlled coronary artery occlusion by an angioplasty balloon in human subjects. J Am Coll Cardiol 1985; 5: 587–592 [DOI] [PubMed] [Google Scholar]
- 25. The TIMI Study group : The Thrombolysis in Myocardial Infarction (TIMI) trial. N Engl J Med 1985; 312: 932–936 [DOI] [PubMed] [Google Scholar]
- 26. Koenig W, Sund M, Frohlich M: C‐reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle‐aged men. Results from the MONICA (Monitoring Trends and Determinations in Cardiovascular Disease) Ausborg cohort study, 1984 to 1992. Circulation 1999; 99: 237–242 [DOI] [PubMed] [Google Scholar]
- 27. Ridker PM, Cushman M, Stampfer MJ: Plasma concentration of C‐reactive protein and risk of developing peripheral vascular disease. Circulation 1998; 97: 425–428 [DOI] [PubMed] [Google Scholar]
- 28. Ellis SG, Vandormael MG, Cowley MJ: Coronary morphologic and clinical determinants of procedural outcome with angioplasty or multivessel coronary disease. Implications for patient selection. Circulation 1990; 82: 1193–1202 [DOI] [PubMed] [Google Scholar]
- 29. White CJ, Ramee SR, Collins TJ: Coronary thrombi increase PTCA risk. Angioscopy as a clinical tool. Circulation 1996; 93: 253–258 [DOI] [PubMed] [Google Scholar]
- 30. Lincoff AM, Popma JJ, Ellis SG, Hacker JA, Topol EJ: Abrupt vessel closure complicating coronary angioplasty: Clinical, angiographic and therapeutic profile. J Am Coll Cardiol 1992; 19: 926–935 [DOI] [PubMed] [Google Scholar]
- 31. Gaspardone A, Crea F, Versaci F: Predictive value of C‐reactive protein after successful coronary artery stenting in patients with stable angina. Am J Cardiol 1998; 82: 515–518 [DOI] [PubMed] [Google Scholar]
- 32. Tomoda H, Aoki N: Prognostic value of C‐reactive protein levels within six hours after the onset of acute myocardial infarction. Am Heart J 2000; 140: 324–328 [DOI] [PubMed] [Google Scholar]
- 33. Buffon A, Liuzzo G, Biasucci LM: Preprocedural serum levels of C‐reactive protein predict early complications and late restenosis after coronary angio‐plasty. J Am Coll Cardiol 1999; 34: 1512–1521 [DOI] [PubMed] [Google Scholar]
- 34. The Epilog Investigators : Platelet glycoprotein IIb/IIIa receptor blockade and low‐dose heparin during percutaneous coronary revascularization. N Engl J Med 1997; 336: 1689–1696 [DOI] [PubMed] [Google Scholar]
- 35. Ambrose JA, Winters SL, Arora AA: Coronary angiographic morphology in myocardial infarction: A link between pathogenesis of unstable angina and myocardial infarction. J Am Coll Cardiol 1985; 6: 1233–1238 [DOI] [PubMed] [Google Scholar]