Background: Elevation of inflammatory markers is a common finding in acute coronary syndrome (ACS). Percutaneous coronary intervention (PCI) also provokes an inflammatory reaction. We evaluated the characteristics of the patients with elevated high sensitivity C-reactive protein (hsCRP) after PCI and whether an increase in hsCRP after PCI predicts long-term prognosis in patients with ACS.
Methods: We studied 612 consecutive patients with ACS who underwent elective coronary stenting. hsCRP levels were serially measured before and after the intervention. Patients were grouped into tertiles according to postprocedural hsCRP levels. 12 months follow-up was obtained and clinical outcomes were compared with postprocedural hsCRP.
Results: Patients with upper tertile revealed higher incidence of myocardial infarction (9.3 vs. 46.6%, p<0.001), multivessel disease (44.9% vs. 62.3%, p=0.002), and complex (B2/C) lesion (68.3 vs. 79.9%, p=0.026) than in patients with lower tertle. White blood cell count, beseline and peak troponin T, and baseline hsCRP were significantly elevated in patients with upper tertile than in those with lower tertile. Patients with upper tertile had a higher predictive value for the occurrence of 1 year major adverse cardiac events (MACE) than in those with lower tertile (Hazard ratio 2.0, p=0.006). In multivariate analysis, postprocedural hsCRP, hematocrit, and creatinine were independent predictors of MACE (p=0.034, 0.036, and p=0.042, respectively).
Conclusion: Postprocedural hsCRP level was associated with higher incidence of MACE in patients with ACS. Postprocedural hsCRP level may reflect pre-existing inflammatory burden, myonecrosis during ACS and PCI, and future cardiovascular outcome.