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Elevated Levels of C-Reactive Protein Associated With Stent Thrombosis: Presented at AHA

By Lexa W. Lee

NEW ORLEANS -- November 14, 2008 -- Patients with elevated levels of C-reactive protein (CRP) before they undergo percutaneous coronary intervention (PCI) with stent implantation have a higher risk of developing stent thrombosis and stent-related death, according to findings presented here at the American Heart Association (AHA) Scientific Sessions.

Stent thrombosis often presents as acute myocardial infarction or death, and is the most serious adverse outcome of coronary stent placement, according to lead investigator Keiji Inoue, MD, Kyoto Second Red Cross Hospital, Kyoto, Japan.

Inflammatory mechanisms may play a crucial role in stent thrombosis. CRP, a marker of systemic inflammation, has been consistently associated with an increased risk of cardiovascular events. Accurate prediction of the risk of these events after angioplasty, or PCI, remains a challenge.

Dr. Inoue and colleagues conducted a study to investigate whether higher CRP levels before PCI were related to an increased risk of stent thrombosis. The study was presented on November 12.

They enrolled 2,516 consecutive patients aged 69 years on average who underwent successful stent implantation. Baseline CRP levels were obtained before the PCI procedure.

Subjects were divided into 2 groups based on whether they had elevated (n = 1,260) or nonelevated (n = 1,256) CRP levels, according to the median value of baseline CRP for data analysis.

The primary endpoint of the study was definite stent thrombosis and the secondary endpoint was cardiac death due to stent thrombosis. The median value of baseline CRP was 2.09 mg/L in all patients.

During the 2-year follow-up, definite stent thrombosis was observed in 29 cases (1.15%); there were 11 deaths related to stent thrombosis (0.44%). There was no significant difference in the rate of stent thrombosis between patients who received bare metal stents and those who received drug-eluting stents.

Patients with CRP levels 2.09 mg/L or greater had a significantly higher incidence of stent thrombosis (1.83% vs 0.48%, P = .0015). Also, the rate of death after stent thrombosis was significantly higher in the group with elevated CRP levels than in the normal CRP group (0.71% vs 0.16%, P = .0349).

The researchers concluded that elevated levels of CRP prior to PCI were significantly associated with the development of stent thrombosis and death related to stent thrombosis.

Baseline CRP levels may be a useful predictor of clinical risk of stent thrombosis in patients treated with coronary stents.

[Presentation title: Prognostic Impact of Preprocedural Levels of C-Reactive Protein on Stent Thrombosis After Coronary Stent Implantation. Presentation 6012]

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