It is unknown whether high-sensitivity C-reactive protein (hs-CRP) predicts outcome
depending on implanted stent type. We investigated the prognostic value of hs-CRP
in relation to type of stent implanted in patients with ST-segment elevation myocardial
infarction (STEMI). Immediately before primary percutaneous coronary intervention
(pPCI), 301 patients had blood drawn. Patients were categorized according to hs-CRP
levels and combination of hs-CRP (≤2 vs >2 mg/L) and stent type (bare metal stent
[BMS] vs drug-eluting stent [DES]). Hs-CRP >2 mg/L (median, hazard ratio 2.7, 95%
confidence interval 1.3 to 5.6, p = 0.007) and the combined variable of hs-CRP >2
mg/L and BMS (hazard ratio 2.4, 95% confidence interval 1.2 to 4.5, p = 0.006) independently
predicted the composite end point of death and MI at 36-month follow-up. There was
a significant interaction (p = 0.006) for hs-CRP and stent type. Survival analysis
demonstrated significant differences for occurrence of death and MI: 4.8% in BMS +
CRP ≤2 mg/L, 11.9% in DES + CRP ≤2 mg/L, 17.6% in DES + CRP >2 mg/L, and 27.9% in
BMS + CRP >2 mg/L. None of the 14 stent thromboses occurred in patients with BMS +
CRP ≤2 mg/L. In conclusion, preprocedure hs-CRP predicts outcome after pPCI in patients
with STEMI. Our hypothesis-generating data indicate that BMS implantation should be
preferred when hs-CRP is ≤2 mg/L and DES when hs-CRP is >2 mg/L to decrease long-term
adverse outcomes including stent thrombosis in patients with STEMI treated with pPCI.
These findings need confirmation in larger randomized clinical trials.
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Article Info
Publication History
Published online: March 25, 2011
Accepted:
January 20,
2011
Received in revised form:
January 20,
2011
Received:
December 14,
2010
Footnotes
This work was supported by the Vera and Flemming Westerberg Foundation, Copenhagen, Denmark.
Identification
Copyright
© 2011 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
