Key result
High baseline CRP levels (>2.3 mg/l) predicted higher one-year mortality compared to low CRP levels (5.8% vs 2.1%; OR 2.77, 95% CI 2.04-3.77; p<0.001) in CAD patients undergoing PCI.
Why the study?
Does baseline CRP level predict one-year mortality and interact with abciximab therapy in patients with CAD undergoing PCI after pre-treatment with 600 mg of clopidogrel?
Meta-Analysis (n=4,847)
Does baseline CRP level predict one-year mortality and interact with abciximab therapy in patients with CAD undergoing PCI after pre-treatment with 600 mg of clopidogrel?
Effect estimate: OR 2.77 (95% CI 2.04-3.77)
Absolute Event Rate: 5.8% vs 2.1%
p-value: p=<0.001
Baseline CRP level predicts one-year mortality and MACE in CAD patients undergoing PCI after clopidogrel pre-treatment, but abciximab does not provide additional benefit in those with high CRP.
High baseline CRP identifies CAD patients at elevated post-PCI mortality risk; confirms its prognostic value and supports targeted inflammation trials.
OBJECTIVE: To assess the prognostic value of the baseline C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) after pre-treatment with 600 mg of clopidogrel and whether there is an interaction between CRP level and abciximab in terms of outcome. DESIGN: Pooled analysis from the ISAR-SWEET, SMART-2, ISAR-REACT and REACT-2 trials. SETTING, METHODS: The study included 4847 patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. The primary outcome was one-year mortality. The combined incidence of death, myocardial infarction and target lesion revascularisation was the secondary outcome. RESULTS: Based on the median value of CRP (2.3 mg/l), patients were divided into two groups: the high-CRP group (n = 2448) and the low-CRP group (n = 2399). During one year, there were 141 deaths (5.8%) in the high-CRP group compared with 51 deaths (2.1%) in the low-CRP group (OR = 2.77, 95% CI 2.04 to 3.77; p<0.001). The incidence of major adverse cardiac events (MACE) was 28% in the high-CRP group compared with 25% in the low-CRP group (OR = 1.13, 95% CI 1.01 to 1.26; p = 0.034). The Cox proportional hazards model showed that high CRP was an independent predictor of one-year mortality (hazard ratio 2.20, 95% CI 1.54 to 3.15; p<0.001 for CRP level >2.3 mg/l vs CRP level < or =2.3 mg/l). No significant interaction was observed between CRP level and abciximab regarding one-year mortality (p = 0.08) or MACE (p = 0.68). CONCLUSION: In patients with CAD undergoing PCI after pretreatment with 600 mg of clopidogrel, baseline CRP level predicts one-year mortality and MACE. Abciximab therapy did not confer any particular beneficial effect in patients with a higher inflammatory burden.
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Iijima et al. (2008) conducted a meta-analysis in Coronary artery disease (CAD) undergoing PCI (n=4,847). High baseline C-reactive protein (CRP >2.3 mg/l) vs. Low baseline C-reactive protein (CRP ≤2.3 mg/l) was evaluated on One-year mortality (OR 2.77, 95% CI 2.04-3.77, p=<0.001). High baseline CRP levels (>2.3 mg/l) predicted higher one-year mortality compared to low CRP levels (5.8% vs 2.1%; OR 2.77, 95% CI 2.04-3.77; p<0.001) in CAD patients undergoing PCI.
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