Influence of late vascular inflammation after using first generation DES on subsequent major adverse cardiac event among patients who underwent percutaneous coronary intervention

Abstract

Background: It is suggested that vascular inflammation after using drug eluting stent (DES) may associate to occurrence of subsequent stent related adverse event. However, its relationship has not been cleared, so we assessed that relationship by measurement of C-reactive protein (CRP) at 8 months after PCI in addition to pre-procedural CRP as marker of vascular inflammation. Methods: The paired CRP (pre-procedure and 8months after PCI) was available in 812 patients who underwent PCI with either using Cypher (492 patients) or TAXUS stent (320patients). Elevated CRP was defined as over 0.2mg/dl. We investigated relationship between those CRPs and occurrence of major adverse cardiac event (MACE) which comprises from all cause death, non-fatal myocardial infarction, and initially unplanned any other revascularization, and target lesion revascularization (TLR). Results: Elevated CRP was seen in 43.2% at pre-procedure, however, it was decreased to 26.8% at late phase after DES implantation. Elevated CRP at both those two times or only late onsets was seen in 16.8%, 10.0% respectively. According to the level of late phase CRP, occurrence of MACE was frequently seen in patients with elevated late phase CRP than non-elevated late phase CRP (median: 1106 days, 43.2% vs. 16.1%, P<0.0001). By multivariate analysis, late phase CRP (HR: 3.07, 95% CI: 2.31-4.07, P<0.0001),statin therapy (HR: 0.68, 95% CI: 0.50-0.93, P<0.015), and CKD (HR: 1.70, 95% CIL 1.27-2.26, P=0.0003) was independent predictor of occurrence of MACE among them. Conclusion: Late phase CRP may be useful to estimate late vascular inflammation as determinant factor of long-term outcomes among patients who underwent DES implantation. CKD might relate with that inflammation.Statin therapy is recommended for all patients.