Effect of Clopidogrel added to aspirin before percutaneous coronary intervention on the risk associated with C-reactive protein

Abstract

Emerging evidence links an elevated baseline inflammatory status to adverse outcomes among patients undergoing percutaneous coronary intervention (PCI). Patients with elevated C-reactive protein (CRP) experience an excess of death and acute myocardial infarction (AMI) within 30-day follow-up, in addition to an increase in the rate of target artery revascularization over the longer term.1–3 However, few therapeutic strategies have demonstrated efficacy in attenuating this ischemic risk. In particular, despite an observed effect on circulating markers of inflammation, abciximab appears to provide similar efficacy among patients with and without evidence of systemic inflammation.3,4 By inhibition of an adenosine diphosphate receptor, thienopyridines attenuate the expression of multiple platelet surface adhesion molecules involved in platelet leukocyte interactions.5 Previous evidence demonstrates the benefits of pretreatment with thienopyridines among patients undergoing PCI.6 We sought to examine whether this reduction in death or AMI is related to the baseline CRP status.