Preprocedural CRP Levels Predict Myocardial Necrosis Post-PCI
Background: Myocardial necrosis as assessed by cardiac troponin elevation occurs frequently after coronary stenting and is associated with adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of systemic inflammation is not known.
Methods: We prospectively studied 208 patients with chronic stable angina who underwent elective coronary stenting. All patients had normal troponin levels before the procedure. Blood samples for high-sensitivity C-reactive protein (CRP) were obtained before the procedure and analyzed using a high-sensitivity kit. Cardiac troponin T (cTnT) was obtained 24 hours after the procedure.
Results: Postprocedural cTnT elevations were observed in 46 (22%) patients. There were 11 (16%), 14 (20%), and 21 (30%) patients with elevated postprocedural cTnT in the first, second, and third CRP tertile, respectively (P for trend = .045). In a multivariate logistic regression model, adjusting for all the significant univariate predictors and for statin therapy, CRP remained a significant independent predictor of postprocedural cTnT elevation with an odds ratio of 2.6 in patients in the third CRP tertile compared with patients in the first CRP tertile (95% CI 1.1-6.0, P = .02). Patients in the third CRP tertile also had higher cTnT elevations compared with patients in the first and second CRP tertile (P = .03).
Conclusions: Elevated baseline CRP levels are associated with higher risk of postprocedural troponin elevations in patients with stable angina undergoing uncomplicated coronary stenting. These results underscore the role of systemic inflammation in the pathogenesis of periprocedural myocardial injury.
Apparently uncomplicated percutaneous coronary interventions (PCIs) are frequently accompanied with myocardial necrosis as assessed by elevation in plasma levels of creatine kinase–MB (CK-MB) and cardiac troponins. Several studies have emphasized the association between minor myocardial necrosis after PCI and adverse short-and long-term prognosis. Cardiac troponins T and I were consistently found to be more sensitive than CK-MB in detecting myocardial necrosis in this setting.
Arterial inflammation has emerged as central to the initiation and progression of atherothrombosis and its complications. C-reactive protein (CRP) is an acute-phase reactant and is the most widely used marker of systemic inflammation. A number of studies suggest an association between baseline CRP levels and adverse outcome after successful PCI. Although the mechanism for this association is unknown, elevated preprocedural CRP levels have been associated with increased risk for both short-and long-term cardiac events. Little is known regarding the role of systemic inflammatory state and post-PCI myocardial necrosis, with two previous studies presenting contradictory results. Therefore, we sought to investigate whether elevated preprocedural CRP levels are associated with increased risk of postprocedural troponin T elevations in patients undergoing elective PCI for chronic stable angina.
Abstract and Introduction
Abstract
Background: Myocardial necrosis as assessed by cardiac troponin elevation occurs frequently after coronary stenting and is associated with adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of systemic inflammation is not known.
Methods: We prospectively studied 208 patients with chronic stable angina who underwent elective coronary stenting. All patients had normal troponin levels before the procedure. Blood samples for high-sensitivity C-reactive protein (CRP) were obtained before the procedure and analyzed using a high-sensitivity kit. Cardiac troponin T (cTnT) was obtained 24 hours after the procedure.
Results: Postprocedural cTnT elevations were observed in 46 (22%) patients. There were 11 (16%), 14 (20%), and 21 (30%) patients with elevated postprocedural cTnT in the first, second, and third CRP tertile, respectively (P for trend = .045). In a multivariate logistic regression model, adjusting for all the significant univariate predictors and for statin therapy, CRP remained a significant independent predictor of postprocedural cTnT elevation with an odds ratio of 2.6 in patients in the third CRP tertile compared with patients in the first CRP tertile (95% CI 1.1-6.0, P = .02). Patients in the third CRP tertile also had higher cTnT elevations compared with patients in the first and second CRP tertile (P = .03).
Conclusions: Elevated baseline CRP levels are associated with higher risk of postprocedural troponin elevations in patients with stable angina undergoing uncomplicated coronary stenting. These results underscore the role of systemic inflammation in the pathogenesis of periprocedural myocardial injury.
Introduction
Apparently uncomplicated percutaneous coronary interventions (PCIs) are frequently accompanied with myocardial necrosis as assessed by elevation in plasma levels of creatine kinase–MB (CK-MB) and cardiac troponins. Several studies have emphasized the association between minor myocardial necrosis after PCI and adverse short-and long-term prognosis. Cardiac troponins T and I were consistently found to be more sensitive than CK-MB in detecting myocardial necrosis in this setting.
Arterial inflammation has emerged as central to the initiation and progression of atherothrombosis and its complications. C-reactive protein (CRP) is an acute-phase reactant and is the most widely used marker of systemic inflammation. A number of studies suggest an association between baseline CRP levels and adverse outcome after successful PCI. Although the mechanism for this association is unknown, elevated preprocedural CRP levels have been associated with increased risk for both short-and long-term cardiac events. Little is known regarding the role of systemic inflammatory state and post-PCI myocardial necrosis, with two previous studies presenting contradictory results. Therefore, we sought to investigate whether elevated preprocedural CRP levels are associated with increased risk of postprocedural troponin T elevations in patients undergoing elective PCI for chronic stable angina.
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