Background and Objectives : It has been reported that the inflammatory response during percutaneous coronary intervention (PCI) is associated with adverse prognosis in patients with stable angina. We examined whether an increase in high-sensitivity C-reactive protein (hsCRP) after PCI predicts long-term prognosis in patients with acute coronary syndrome (ACS).
Subjects and Methods : We studied consecutive 360 patients with ACS within 72 hours who underwent elective coronary stenting. Blood samples for hsCRP and troponin T were obtained before the procedure and at 6 hours and 24 hours after PCI. Inflammatory response to PCI was calculated as the difference between the peak postprocedural hsCRP level and preprocedural hsCRP level (delta CRP). 12 months follow-up was obtained in all patients and clinical outcomes were compared with delta CRP.
Results : Mean delta CRP was 8.1짹22.2 mg/L and median value was 2.55 mg/L. We divided the patients according to median value of delta CRP; Group I <2.55 mg/dL, Group II ���2.55 mg/dL. The patients with group II revealed higher incidence of myocardial infarction (36.1 vs. 15.0%, p<0.001), multivessel disease (60.0 vs. 48.9%, p=0.034), complex lesion (81.7 vs. 67.2%, p=0.002) and postprocedural troponin elevation (19.4 vs. 8.9%, p=0.004). Major adverse cardiac event (MACE) was more developed in group II than in group I (hazard ratio 1.8, 95% CI 1.1~3.1, p=0.027). Multivariate analysis revealed that the delta CRP ���2.55 mg/dL (OR 1.8, 95% CI 1.0-3.3, p=0.041) and myocardia infarction (OR 2.4, 95% CI 1.3-4.5, p=0.006) were independent predictors of MACE.
Conclusion : In conclusion, postprocedural hsCRP elevation was associated with higher incidence of MACE in patients with ACS. These results emphasized the need of potent anti-inflammatory therapy during the peri-PCI period.