Key result
Elevated preprocedural high-sensitivity C-reactive protein levels (≥0.5 mg/dl) were significantly associated with increased neointimal hyperplasia area (3.0 vs 1.9 mm²) at 6 months after coronary stenting.
Why the study?
Does elevated pre-procedural hs-CRP predict neointimal hyperplasia and restenosis after coronary stenting, and does statin therapy reduce restenosis in these patients?
Cohort (n=100)
No
Does elevated pre-procedural hs-CRP predict neointimal hyperplasia and restenosis after coronary stenting, and does statin therapy reduce restenosis in these patients?
Absolute Event Rate: 3% vs 1.9%
p-value: p=0.001
Elevated pre-procedural hs-CRP predicts increased neointimal hyperplasia and restenosis after coronary stenting, which can be significantly attenuated by statin therapy.
Elevated preprocedural hs-CRP may flag higher neointimal hyperplasia risk after stenting; hypothesis-generating and should not yet change practice.
BACKGROUND: Recent data indicate that an elevated serum level of high-sensitivity C-reactive protein (hs-CRP) predicts the risk of recurrent coronary events, and that statin therapy decreases the risk of coronary events. This study assessed the relationship between the pre-procedural hs-CRP level and in-stent neointimal hyperplasia (NIH) after stenting and the effects of statins on the relationship between restenosis after stenting and the serum hs-CRP levels of patients with coronary artery disease. METHODS AND RESULTS: This study included 100 patients who underwent stent implantation for angiographically significant stenosis. Patients were divided into a normal C-reactive protein (CRP) group (<0.5 mg/dl, n=59) and elevated CRP group (>or=0.5 mg/dl, n=41). All patients underwent angiographic and intravascular ultrasound follow-up at 6 months. The baseline CRP level was 0.29+/-0.08 mg/dl in the normal CRP group and 2.90+/-2.31 mg/dl in the elevated CRP group. The NIH cross-sectional area (CSA) in the minimal lumen CSA at follow-up was significantly larger in the elevated CRP group compared with the normal CRP group (1.9+/-1.3 mm2 vs 3.0+/-1.5 mm2, p=0.001). A significant positive correlation was found between pre-interventional CRP level and NIH area (r=0.52, p<0.001). In patients with normal CRP, an association between statin therapy and restenosis was not observed. However, when the analysis was confined to patients with elevated CRP, statin therapy significantly reduced the restenosis rate (20% vs 37.5%, p=0.031). In the normal CRP group, the intra-stent neointimal area at 6 months was not different between the non-statin and statin groups (2.2+/-1.4 mm2 vs 1.8+/-1.1 mm2). However, in the elevated CRP group, statin therapy significantly decreased the neointimal area at 6-month follow-up (3.6+/-1.7 mm2 vs 2.4+/-1.3 mm2, p<0.001). CONCLUSION: Measuring the pre-interventional hs-CRP level may help predict the development of restenosis after stenting and statin therapy will significantly reduce the restenosis rate in patients with an elevated hs-CRP.
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Hong et al. (2005) conducted a cohort in Coronary Artery Disease (n=100). Elevated preprocedural high-sensitivity C-reactive protein (≥0.5 mg/dl) vs. Normal high-sensitivity C-reactive protein (<0.5 mg/dl) was evaluated on Neointimal hyperplasia cross-sectional area at 6 months (mm²) (p=0.001). Elevated preprocedural high-sensitivity C-reactive protein levels (≥0.5 mg/dl) were significantly associated with increased neointimal hyperplasia area (3.0 vs 1.9 mm²) at 6 months after coronary stenting.
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