이종영, 이정우, 정인현, 서존, 박덕우, 이승환, 김영학, 이철환, 홍명기, 김재중, 박성욱, 박승정 |
Background :The safety concerns regarding stent thrombosis (ST) have been raised with the use of DES. Because the multifactorial processes are involved to the development of ST, the accurate risk prediction and stratification for these events is difficult. Methods : We examined the predictive value of preprocedural levels of CRP on the long-term clinical outcomes in 2,632 patients with DES implantation. The end point of the study was ST and the composite of death or MI. Results :During the 3 year follow-up, patients (n=923) with high serum levels of CRP (≥3 mg/L) had a significantly higher incidence of ST, as compared to those (n=1,709) with normal CRP levels (3.1% vs. 1.7%, HR 1.90; 95% CI,P=0.027). Also, the rate of death or MI was significantly higher in patients with elevated levels of CRP (7.0% vs. 3.3%, HR 2.32; 95% CI,1.57-3.43; P<0.001). In multivariate Cox-regression analysis, elevated CRP levels(HR 1.85; 95% CI,P=0.032), LVEF(HR 0.96; 95% CI,P=0.018), and the number of stents per patients(HR 1.01; 95% CI,P=0.003) were the independent predictors of ST. Elevated CRP levels(HR 1.78; 95% CI,P=0.011), LVEF(HR 0.97; 95% CI,P=0.004), and older age(HR 1.05;95% CI,P<0.001) were the independent predictors of the composite of death or MI. Conclusions: Elevated preprocedural levels of CRP were significantly associated with the development of ST and death/MI after DES implantation. Therefore, inflammatory risk stratification in patients treated with DES may be helpful to guide the adjunctive medical therapeutics for prevention of these serious events.
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