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Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein

BACKGROUND: Elevation of C‐reactive protein (CRP) as a marker of vascular inflammation at a late phase of drug‐eluting stent (DES) implantation may predict subsequent major adverse cardiac events (MACE). METHODS AND RESULTS: In 1234 consecutive patients undergoing DES implantation, CRP was measured...

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Autores principales: Shiba, Masanori, Itaya, Hideki, Iijima, Raisuke, Nakamura, Masato
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079011/
https://www.ncbi.nlm.nih.gov/pubmed/27664802
http://dx.doi.org/10.1161/JAHA.116.003354
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author Shiba, Masanori
Itaya, Hideki
Iijima, Raisuke
Nakamura, Masato
author_facet Shiba, Masanori
Itaya, Hideki
Iijima, Raisuke
Nakamura, Masato
author_sort Shiba, Masanori
collection PubMed
description BACKGROUND: Elevation of C‐reactive protein (CRP) as a marker of vascular inflammation at a late phase of drug‐eluting stent (DES) implantation may predict subsequent major adverse cardiac events (MACE). METHODS AND RESULTS: In 1234 consecutive patients undergoing DES implantation, CRP was measured both before (baseline) and 8 to 12 months after (late phase) stenting, and the relationship between elevation of CRP (>2.0 mg/L) and subsequent MACE (all cause death, nonfatal myocardial infarction, target lesion revascularization, and other additional revascularization) was assessed. As results, CRP was elevated in 38.0% of patients at baseline and in 23.6% during late phase (P<0.0001), and hazard ratio (HR) for MACE was 1.52 (95% confidence interval [95% CI] 1.21–1.93, P=0.0004) at baseline versus 4.00 (95% CI 3.16–5.05, P<0.0001) in late phase. By multivariable analysis, late‐phase CRP elevation (HR 3.60, 95% CI: 2.78–4.68, P<0.0001), chronic kidney disease (CKD) (HR 1.41, 95% CI: 1.10–1.84, P=0.01), and number of diseased segments (HR 1.19, 95% CI: 1.08–1.30, P=0.0002) were positive predictors of MACE, whereas statin use (HR 0.66, 95% CI 0.50–0.87, P=0.003) was a negative predictor. Propensity score–matched analysis also confirmed the effect of late‐phase CRP on MACE (HR 3.39, 95% CI 2.52–4.56, P<0.0001). In prediction of the late‐phase CRP elevation, CKD (odds ratio [OR] 1.71, 95% CI 1.24–2.36, P=0.001) and baseline CRP elevation (OR 3.48, 95% CI 2.55–4.74, P<0.0001) were positive predictors, whereas newer generation DES (OR 0.59, 95% CI 0.41–0.84, P=0.003) and statin therapy (OR 0.68, 95% CI 0.47–0.97, P=0.03) were negative predictors. CONCLUSIONS: Monitoring the late‐phase CRP may be helpful to identify a high‐risk subset for MACE among patients undergoing DES implantation.
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spelling pubmed-50790112016-10-28 Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein Shiba, Masanori Itaya, Hideki Iijima, Raisuke Nakamura, Masato J Am Heart Assoc Original Research BACKGROUND: Elevation of C‐reactive protein (CRP) as a marker of vascular inflammation at a late phase of drug‐eluting stent (DES) implantation may predict subsequent major adverse cardiac events (MACE). METHODS AND RESULTS: In 1234 consecutive patients undergoing DES implantation, CRP was measured both before (baseline) and 8 to 12 months after (late phase) stenting, and the relationship between elevation of CRP (>2.0 mg/L) and subsequent MACE (all cause death, nonfatal myocardial infarction, target lesion revascularization, and other additional revascularization) was assessed. As results, CRP was elevated in 38.0% of patients at baseline and in 23.6% during late phase (P<0.0001), and hazard ratio (HR) for MACE was 1.52 (95% confidence interval [95% CI] 1.21–1.93, P=0.0004) at baseline versus 4.00 (95% CI 3.16–5.05, P<0.0001) in late phase. By multivariable analysis, late‐phase CRP elevation (HR 3.60, 95% CI: 2.78–4.68, P<0.0001), chronic kidney disease (CKD) (HR 1.41, 95% CI: 1.10–1.84, P=0.01), and number of diseased segments (HR 1.19, 95% CI: 1.08–1.30, P=0.0002) were positive predictors of MACE, whereas statin use (HR 0.66, 95% CI 0.50–0.87, P=0.003) was a negative predictor. Propensity score–matched analysis also confirmed the effect of late‐phase CRP on MACE (HR 3.39, 95% CI 2.52–4.56, P<0.0001). In prediction of the late‐phase CRP elevation, CKD (odds ratio [OR] 1.71, 95% CI 1.24–2.36, P=0.001) and baseline CRP elevation (OR 3.48, 95% CI 2.55–4.74, P<0.0001) were positive predictors, whereas newer generation DES (OR 0.59, 95% CI 0.41–0.84, P=0.003) and statin therapy (OR 0.68, 95% CI 0.47–0.97, P=0.03) were negative predictors. CONCLUSIONS: Monitoring the late‐phase CRP may be helpful to identify a high‐risk subset for MACE among patients undergoing DES implantation. John Wiley and Sons Inc. 2016-09-24 /pmc/articles/PMC5079011/ /pubmed/27664802 http://dx.doi.org/10.1161/JAHA.116.003354 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Shiba, Masanori
Itaya, Hideki
Iijima, Raisuke
Nakamura, Masato
Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title_full Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title_fullStr Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title_full_unstemmed Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title_short Influence of Late Vascular Inflammation on Long‐Term Outcomes Among Patients Undergoing Implantation of Drug Eluting Stents: Role of C‐Reactive Protein
title_sort influence of late vascular inflammation on long‐term outcomes among patients undergoing implantation of drug eluting stents: role of c‐reactive protein
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5079011/
https://www.ncbi.nlm.nih.gov/pubmed/27664802
http://dx.doi.org/10.1161/JAHA.116.003354
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