Influence of Late Vascular Inflammation on Long-Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C-Reactive Protein

Background: elevation of c-reactive protein (crp) as a marker of vascular inflammation at a late phase of drug-eluting stent (des) implantation may predict subsequent major adverse cardiac events (mace). methods and results: in 1234 consecutive patients undergoing des implantation,crp was measured both before (baseline) and 8 to 12 months after (late phase) stenting,and the relationship between elevation of crp (>2.0 mg/l) and subsequent mace (all cause death,nonfatal myocardial infarction,target lesion revascularization,and other additional revascularization) was assessed. as results,crp was elevated in 38.0% of patients at baseline and in 23.6% during late phase (p<0.0001),and hazard ratio (hr) for mace was 1.52 (95% confidence interval [95% ci] 1.21-1.93,p=0.0004) at baseline versus 4.00 (95% ci 3.16-5.05,p<0.0001) in late phase. by multivariable analysis,late-phase crp elevation (hr 3.60,95% ci: 2.78-4.68,p<0.0001),chronic kidney disease (ckd) (hr 1.41,95% ci: 1.10-1.84,p=0.01),and number of diseased segments (hr 1.19,95% ci: 1.08-1.30,p=0.0002) were positive predictors of mace,whereas statin use (hr 0.66,95% ci 0.50-0.87,p=0.003) was a negative predictor. propensity score-matched analysis also confirmed the effect of late-phase crp on mace (hr 3.39,95% ci 2.52-4.56,p<0.0001). in prediction of the late-phase crp elevation,ckd (odds ratio [or] 1.71,95% ci 1.24-2.36,p=0.001) and baseline crp elevation (or 3.48,95% ci 2.55-4.74,p<0.0001) were positive predictors,whereas newer generation des (or 0.59,95% ci 0.41-0.84,p=0.003) and statin therapy (or 0.68,95% ci 0.47-0.97,p=0.03) were negative predictors. conclusions: monitoring the late-phase crp may be helpful to identify a high-risk subset for mace among patients undergoing des implantation. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.