The role of C-reactive protein in percutaneous coronary intervention
Year: 2004
Type: dissertation
Study design: Observational Study
Abstract: An elevated preprocedural plasma or serum C-reactive protein (CRP) level\nin patients undergoing percutanous coronary intervention (PCI) is\nassociated with short-, intermediate- and long-term outcome. Furthermore,\nthe procedure itself has been shown to provoke an inflammatory reaction\nas shown by increased plasma CRP levels after PCI. The research programme\nresulting in this thesis focus on the role of CRP and inflammation in\npatients undergoing PCI.\nIn study I 400 consecutive patients with serum levels of troponin T =\n0.03 µg/l presenting with stable or unstable angina pectoris were\ninvestigated. Twenty-one percent of the patients experienced a myocardial\ninfarction during PCI. The median value of CRP before the procedure was\n1.83 (0.12-99.7) mg/l. No difference was seen in CRP levels before PCI\nbetween patients without or with myocardial infarction during PCI.\nMultivariate analysis identified stent implantation, procedure time and\ncomplications during the procedure as independent predictors of\nmyocardial infarction during PCI.\nIn study II 121 patients with stable angina pectoris were enrolled. 100\npatients were treated with a thrombin-based (Duett sealing) femoral\nartery closure device and 121 patients were treated with the FemoStop\ndevice. Irrespective of femoral artery closure device serum CRP and serum\namyloid A (SAA) levels increased significantly after PCI. The increase\nwas more pronounced in the Duett sealing device group compared with the\nFemoStop device group.\nIn study III 100 patients with stable angina pectoris scheduled for\nelective PCI were prospectively enrolled. Antibodies against different\npathogens were examined. Plasma CRP and IL-6 levels were measured before\nand 6, 24, 48, 72 hours after PCI. Neither infection with single or\nmultiple pathogens nor a minor troponin T elevation after PCI was\nassociated with plasma CRP or interleukin-6 (IL-6) area under the curves\n(AUCs). Patients treated with stent implantation had higher plasma CRP\nand IL-6 AUCs compared with patients treated with balloon angioplasty\nalone\nStudy IV 891 consecutive patients presenting with stable or unstable\nangina pectoris undergoing a variety of PCIs were investigated. Serum\nconcentrations of CRP and troponin T were determined before and the day\nafter PCI. The mean follow-up time after PCI was 2.6 years. In\nmultivariate analysis, patients in the highest tertile of CRP, induced by\nPCI, had an increased risk (risk ratio (RR) 2.48 [95% confidence interval\n(CI) 1.42-4.33]) for death or non-fatal myocardial infarction.\nFurthermore, patients in the second (RR 1.75 [95% CI 1.14-2.75]) and\nthird (RR 2.15 [95% CI 1.37-3.36]) tertiles of the CRP response had an\nincreased risk for coronary revascularization. Patients with\nperiprocedural myocardial infarction with a postprocedural troponin T >\n0.14 µg/l had an increased risk for death or non-fatal myocardial\ninfarction (RR 2.65 [95% CI 1.02-6.83]).\nConclusion: Periprocedural factors, whereas not the preprocedural CRP\nwere associated with the risk of myocardial infarction during PCI.\nHowever, an elevated serum CRP concentration in response to PCI is a\nstrong independent predictor of death or non-fatal myocardial infarction\nand coronary revascularization independent on myocardial injury during\nthe procedure. Factors related to the procedure are influenced the CRP\nresponse to PCI. The results emphasize the role of CRP in coronary artery\ndisease (CAD), and the need to develop treatments that block the increase\nin CRP in CAD.
Source: Figshare
Author: Nawzad Saleh
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W1900378617