Background It have been reported that the inflammatory response during percutaneous coronary intervention (PCI) was associated with adverse prognosis in patients with stable angina. However, changes of C-reactive protein (CRP) levels after PCI in patients with acute coronary syndrome were not well evaluated. We examined whether an increase in CRP after PCI predicts long-term prognosis in patients with acute coronary syndrome.
Methods We studied consecutive 216 patients with acute coronary syndrome within 72 hours who underwent elective coronary stenting. Blood samples for high sensitivity CRP and troponin T (TnT) were obtained before the procedure and at 6 hours, 24 hours after PCI. Inflammatory response to PCI was calculated as the difference between peak postprocedural hsCRP level and preprocedural hsCRP level (ΔCRP). 12 months follow-up was obtained in all patients and compared clinical outcomes with ΔCRP.
Results Major adverse cardiac events (MACE) were developed in 37 patients (17.1%) during 12 months, which was 6 cases in cardiac death, 6 cases in non fatal MI, 25 cases in revascularization. Baseline CRP level was not difference between the two groups, but ΔCRP was significantly higher in the patients with MACE than those without MACE (4.8±11.2 vs. 13.9±25.9 mg/L, p=0.043). Mean ΔCRP was 6.3±15.1 mg/dL, and median value was 2.6 mg/dL. ΔCRP was significantly positively correlated with troponin T response to PCI (r=0.257, p<0.001). Multivariate analysis revealed the postprocedural CRP elevation (OR 3.0, 95% CI 1.1-8.2, p=0.031) and complex lesion (OR 4.9, 95% CI 1.4-17.4, p=0.013) were significant independent predictor of MACE.
Conclusions Postprocedural CRP elevation was associated with higher incidence of MACE in patients with acute coronary syndrome. These results emphasized the need of potent anti-inflammatory therapy during peri-PCI period.
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