Circulation. 2001;104:992-997
doi: 10.1161/hc3401.095074
doi: 10.1161/hc3401.095074
(Circulation. 2001;104:992.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Incremental Prognostic Value of Elevated Baseline C-Reactive Protein Among Established Markers of Risk in Percutaneous Coronary Intervention
From the Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio.
Correspondence to Stephen G. Ellis, MD, Department of Cardiology, Cleveland Clinic Foundation, Desk F25, 9500 Euclid Ave, Cleveland, OH 44195. E-mail elliss{at}ccf.org
Background— Established methods of risk assessment in percutaneous coronary intervention have focused on clinical and anatomical lesion characteristics. Emerging evidence indicates the substantial contribution of inflammatory processes to short-term and long-term outcomes in coronary artery disease.
Methods and Results— Within a single-center registry of contemporary percutaneous coronary revascularization strategies with postprocedural creatine kinase and clinical events routinely recorded, we assessed the association of baseline C-reactive protein with death or myocardial infarction within the first 30 days. Predictive usefulness of baseline C-reactive protein within the context of established clinical and angiographic predictors of risk was also examined. Among 727 consecutive patients, elevated baseline C-reactive protein before percutaneous coronary intervention was associated with progressive increase in death or myocardial infarction at 30 days (lowest quartile, 3.9%, versus highest quartile, 14.2%; P=0.002). Among clinical and procedural characteristics, baseline C-reactive protein remained independently predictive of adverse events, with the highest quartile of C-reactive protein associated with an odds ratio for excess 30-day death or myocardial infarction of 3.68 (95% CI, 1.51 to 8.99; P=0.004). A predictive model that included baseline C-reactive protein quartiles, American College of Cardiology/American Heart Association lesion score, acute coronary syndrome presentation, and coronary stenting appears strongly predictive of 30-day death or myocardial infarction within this population (C-statistic, 0.735) and among individual patients (Brier score, 0.006).
Conclusions— Elevated baseline C-reactive protein portends heightened risk of 30-day death or myocardial infarction after coronary intervention. Coupled anatomic, clinical, and inflammatory risk stratification demonstrates strong predictive utility among patients undergoing percutaneous coronary intervention and may be useful for guiding future strategies.
Key Words: angioplasty • stents • inflammation
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|
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|
|
|
|
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|
|
|
|
 |
|
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|
|
|
 |
|
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|
|
|
|
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|
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|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
H S Gurm, D L Bhatt, A M Lincoff, J E Tcheng, D J Kereiakes, N S Kleiman, G Jia, and E J Topol Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials Heart, October 1, 2003; 89(10): 1200 - 1204. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
 M. A. Zimmerman, C. H. Selzman, C. Cothren, A. C. Sorensen, C. D. Raeburn, and A. H. Harken Diagnostic Implications of C-Reactive Protein Arch Surg, February 1, 2003; 138(2): 220 - 224. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. T.H. Yeh and J. T. Willerson Coming of Age of C-Reactive Protein: Using Inflammation Markers in Cardiology Circulation, January 28, 2003; 107(3): 370 - 371. [Full Text] [PDF]
|
|
|
|
|
|
T. A. Pearson, G. A. Mensah, R. W. Alexander, J. L. Anderson, R. O. Cannon III, M. Criqui, Y. Y. Fadl, S. P. Fortmann, Y. Hong, G. L. Myers, et al. Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association Circulation, January 28, 2003; 107(3): 499 - 511. [Full Text] [PDF]
|
|
|
|
|
|
S. R. Steinhubl, P. B. Berger, J. T. Mann III, E. T. A. Fry, A. DeLago, C. Wilmer, E. J. Topol, and for the CREDO Investigators Early and Sustained Dual Oral Antiplatelet Therapy Following Percutaneous Coronary Intervention: A Randomized Controlled Trial JAMA, November 20, 2002; 288(19): 2411 - 2420. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Bhatt, E. J. Topol, I. Kushner, and A. Sehgal The Arterial Inflammation Hypothesis Arch Intern Med, October 28, 2002; 162(19): 2249 - 2251. [Full Text] [PDF]
|
|
|
|
|
|
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|
|
|
|
|
|
J. K. Plenge, T. L. Hernandez, K. M. Weil, P. Poirier, G. K. Grunwald, S. M. Marcovina, and R. H. Eckel Simvastatin Lowers C-Reactive Protein Within 14 Days: An Effect Independent of Low-Density Lipoprotein Cholesterol Reduction Circulation, September 17, 2002; 106(12): 1447 - 1452. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. L. Bhatt and E. J. Topol Need to Test the Arterial Inflammation Hypothesis Circulation, July 2, 2002; 106(1): 136 - 140. [Full Text] [PDF]
|
|
|
|
|
|
G.J. Blake and P.M. Ridker C-reactive protein and prognosis after percutaneous coronary intervention Eur. Heart J., June 2, 2002; 23(12): 923 - 925. [Full Text] [PDF]
|
|
|
|
 |
|
 Elevated CRP Level Predicts PCI Risk Journal Watch Cardiology, November 9, 2001; 2001(1109): 3 - 3. [Full Text]
|
|
|
|
 |
|
 G. J. Blake and P. M. Ridker Novel Clinical Markers of Vascular Wall Inflammation Circ. Res., October 26, 2001; 89(9): 763 - 771. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. W. Chan, D. L. Bhatt, D. P. Chew, M. J. Quinn, D. J. Moliterno, E. J. Topol, and S. G. Ellis Early and Sustained Survival Benefit Associated With Statin Therapy at the Time of Percutaneous Coronary Intervention Circulation, February 12, 2002; 105(6): 691 - 696. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Verma, S.-H. Li, M. V. Badiwala, R. D. Weisel, P. W.M. Fedak, R.-K. Li, B. Dhillon, and D. A.G. Mickle Endothelin Antagonism and Interleukin-6 Inhibition Attenuate the Proatherogenic Effects of C-Reactive Protein Circulation, April 23, 2002; 105(16): 1890 - 1896. [Abstract] [Full Text] [PDF]
|
|