Pre-procedural C-reactive protein levels and clinical outcomes after percutaneous coronary interventions with and without abciximab: pooled analysis of four ISAR trials

• Published in: Heart (British Cardiac Society) Vol. 95; no. 2; pp. 107 - 112
• Main Authors: Iijima, R, Byrne, R A, Ndrepepa, G, Braun, S, Mehilli, J, Berger, P B, Schömig, A, Kastrati, A
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.02.2009; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Angioplasty, Balloon, Coronary; Antibodies, Monoclonal - therapeutic use; Biological and medical sciences; Biomarkers - blood; C-Reactive Protein - metabolism; Cardiology. Vascular system; Coronary Disease - mortality; Coronary Disease - therapy; Diseases of the cardiovascular system; Female; Heart attacks; Humans; Immunoglobulin Fab Fragments - therapeutic use; Male; Medical sciences; Mortality; Multicenter Studies as Topic; Myocardial Infarction - mortality; Myocardial Infarction - prevention & control; Platelet Aggregation Inhibitors - therapeutic use; Preoperative Care; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Randomized Controlled Trials as Topic; Stents; Studies; Ticlopidine - analogs & derivatives; Ticlopidine - therapeutic use; Abciximab; Prognosis; Angioplasty; Analysis; Coronary artery; Instrumentation therapy; Evolution; Level; Pool; Circulatory system; Cardiology; C reactive protein
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2008.153635

Objective: To assess the prognostic value of the baseline C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) after pre-treatment with 600 mg of clopidogrel and whether there is an interaction between CRP level and abciximab in terms of outcome. Design: Pooled analysis from the ISAR-SWEET, SMART-2, ISAR-REACT and REACT-2 trials Setting, methods: The study included 4847 patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. The primary outcome was one-year mortality. The combined incidence of death, myocardial infarction and target lesion revascularisation was the secondary outcome. Results: Based on the median value of CRP (2.3 mg/l), patients were divided into two groups: the high-CRP group (n = 2448) and the low-CRP group (n = 2399). During one year, there were 141 deaths (5.8%) in the high-CRP group compared with 51 deaths (2.1%) in the low-CRP group (OR = 2.77, 95% CI 2.04 to 3.77; p<0.001). The incidence of major adverse cardiac events (MACE) was 28% in the high-CRP group compared with 25% in the low-CRP group (OR = 1.13, 95% CI 1.01 to 1.26; p = 0.034). The Cox proportional hazards model showed that high CRP was an independent predictor of one-year mortality (hazard ratio 2.20, 95% CI 1.54 to 3.15; p<0.001 for CRP level >2.3 mg/l vs CRP level ⩽2.3 mg/l). No significant interaction was observed between CRP level and abciximab regarding one-year mortality (p = 0.08) or MACE (p = 0.68). Conclusion: In patients with CAD undergoing PCI after pretreatment with 600 mg of clopidogrel, baseline CRP level predicts one-year mortality and MACE. Abciximab therapy did not confer any particular beneficial effect in patients with a higher inflammatory burden.