Korean Circ J.  2008 Mar;38(3):135-139. 10.4070/kcj.2008.38.3.135.

Changes of C-reactive Protein are Associated With Myocardial Injury After Successful Percutaneous Coronary Intervention

• Rhee SJ
• Yun KH
• Oh SK
• Park EM
• Lee EM
• Yoo NJ
• Kim NH
• Jeong JW

• KMID: 2225829
• DOI: http://doi.org/10.4070/kcj.2008.38.3.135

Abstract

BACKGROUND AND OBJECTIVES
Myocardial injury after percutaneous coronary intervention (PCI) occurs frequently and it is associated with an adverse clinical outcome. Mechanical factors have been implicated in this complication and the role of inflammation has not yet been clearly determined. We evaluated the effect of an inflammatory response during PCI on periprocedural myocardial injury.
SUBJECTS AND METHODS
We prospectively studied 231 patients (mean age: 62.8+/-10.6 years, males: 60.6%) who underwent elective coronary stenting. For the exclusion of mechanical injury to the myocardium, we excluded those patients who developed complications during PCI. Blood samples for measuring the high sensitivity C-reactive protein (hsCRP) and troponin T (TnT) were obtained before the procedure and at 6 hours and 24 hours after PCI. The inflammatory response to PCI was calculated as the difference between the peak postprocedural hsCRP level and the preprocedural hsCRP level (delta CRP). We divided the patients according to the median value of delta CRP: Group I <2.2 mg/dL and Group II > or =2.2 mg/dL.
RESULTS
Postprocedural TnT elevation was were observed in 72 (31.2%) patients. The baseline clinical and angiographic characteristics were not difference between the two groups. The incidence of any TnT elevations was higher in the Group II than that in Group I (19.8% vs 42.6%, respectively, p<0.001). The incidences of TnT levels over 3 times the upper normal limit and 5 times the upper normal limit were also higher in Group II than in Group I (11.2% vs 21.7%, respectively, p=0.031, for a TnT level 3 times the upper normal limit, and 6.0% vs 13.9%, respectively, for a TnT level 5 times the upper normal limit). Multivariate analysis revealed that postprocedural hsCRP elevation and complex lesion were the significant independent predictors of postprocedural TnT elevation.
CONCLUSION
Elevated hsCRP levels were associated with a higher risk of postprocedural troponin elevation in patients undergoing uncomplicated PCI. These results emphasized the role of inflammation in the pathogenesis of periprocedural myocardial injury.

Keyword

Percutaneous transluminal angioplasty; Stents; C-reactive protein; Inflammation

MeSH Terms

Angioplasty
C-Reactive Protein
Humans
Incidence
Inflammation
Multivariate Analysis
Myocardium
Percutaneous Coronary Intervention
Prospective Studies
Stents
Trinitrotoluene
Troponin
Troponin T
C-Reactive Protein
Trinitrotoluene
Troponin
Troponin T

Figure

• 

  Fig. 1 Incidence of postprocedural troponin T elevations >1, 3 to 5, and >5 times above the upper normal limit according to the delta C-reactive protein (CRP).

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