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Biomarker unlikely beneficial to PCI outcomes
Routine measurement of high-sensitivity C-reactive protein in patients undergoing PCI is unlikely to yield information that improves outcomes, according to study data appearing in Circulation: Cardiovascular Interventions.
To determine whether high-sensitivity CRP (hsCRP) is a useful biomarker for risk stratification in PCI, researchers conducted a prospective study among 513 patients undergoing non-emergency PCI and examined the relationship between pre- and postprocedural hsCRP levels and outcomes.
Patients with high hsCRP had significantly more adverse clinical characteristics. Preprocedural hsCRP level was an independent predictor of periprocedural MI (OR per doubling of hsCRP=1.15; 95% CI, 1.01-1.31).
During 5 years of follow-up, patients with high preprocedural hsCRP had a higher unadjusted mortality (29.7% vs. 9.9%; P<.001) and the combined endpoint of death or MI (36.5% vs. 16%; P<.001). For postprocedural hsCRP, unadjusted mortality (27.1% vs. 12.5%; P<.001) and the combined endpoint of death or MI (34.9% vs. 17.5%; P<.001) were also significantly higher at 5 years.
After multivariable adjustment, neither preprocedural hsCRP levels (HR per doubling=0.96; 95% CI, 0.92-1.00) nor postprocedural hsCRP levels (HR=0.98; 95% CI, 0.94-1.02) were significantly associated with mortality.
“Our findings corroborate the view that, in general, it is the atherosclerotic burden and disease activity that determine long-term clinical outcomes after PCI rather than inflammation per se,” researchers wrote. “The inflammatory response to PCI (delta CRP) is also determined by baseline patient characteristics and, in general, is not secondary to periprocedural myocardial injury. Thus, our findings do not support a role for routine measurement of hsCRP in the management of patients undergoing PCI in contemporary practice.”
Disclosure: The researchers report no relevant financial disclosures.