Association of baseline C-reactive protein levels with periprocedural myocardial injury in patients undergoing percutaneous bifurcation intervention: A CACTUS study subanalysis

Giampaolo Niccoli, Gregory A. Sgueglia, Azeem Latib, Filippo Crea, Antonio Colombo

Research output: Contribution to journalArticle

Abstract

Objectives To assess the predictive value of C-reactive protein (CRP) on periprocedural myocardial injury (PMI), evaluated by creatine kinase-myocardial band isoform (CK-MB) elevation in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for the treatment of coronary bifurcation lesions is actually unknown. Background Systemic inflammation as assessed by CRP has been associated with averse events after DES implantation. After PCI, the occurrence of PMI is common and has also been associated with worse outcomes. Finally, bifurcations are frequently encountered anatomically complex lesions which the treatment is associated with higher complication rate compared with simple lesions. Methods A total of 96 patients (66 ± 10 years, 70 men) from the Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents (CACTUS) trial who had baseline CRP dosage and both baseline and postprocedural CK-MB measurement were included. Results A complex bifurcation strategy was implemented in 53 (55%) patients, and angiographic success was achieved in all but two (2%) patients. Periprocedural myocardial necrosis (increase of CK-MB between one and three times the upper limit of normal [ULN]) was observed in 12 (13%) patients, and four (4%) patients had PCI-related myocardial infarction (increase of CK-MB more than three times ULN). Notably, progressively higher CRP levels were observed in patients with different increase in CK-MB (P = 0.041). Moreover, CRP >1 mg/L significantly predicted CK-MB rise (odds ratio 5.6, 95% confidence interval 1.5-4.3, P = 0.011). Conclusion In the setting of true coronary bifurcations treated by DES, baseline CRP levels were significantly associated with both the incidence and the extent of PMI. © 2013 Wiley Periodicals, Inc.

Original languageEnglish
JournalCatheterization and Cardiovascular Interventions
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 1 2014

Fingerprint

MB Form Creatine Kinase
Sirolimus
C-Reactive Protein
Stents
Protein Isoforms
Wounds and Injuries
Drug-Eluting Stents
Percutaneous Coronary Intervention
Necrosis
Odds Ratio
Myocardial Infarction
Confidence Intervals
Inflammation
Incidence
Therapeutics

Keywords

  • bifurcations
  • C-reactive protein
  • drug-eluting stents
  • periprocedural myocardial injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Association of baseline C-reactive protein levels with periprocedural myocardial injury in patients undergoing percutaneous bifurcation intervention : A CACTUS study subanalysis. / Niccoli, Giampaolo; Sgueglia, Gregory A.; Latib, Azeem; Crea, Filippo; Colombo, Antonio.

In: Catheterization and Cardiovascular Interventions, Vol. 83, No. 1, 01.01.2014.

Research output: Contribution to journalArticle

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abstract = "Objectives To assess the predictive value of C-reactive protein (CRP) on periprocedural myocardial injury (PMI), evaluated by creatine kinase-myocardial band isoform (CK-MB) elevation in patients undergoing percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation for the treatment of coronary bifurcation lesions is actually unknown. Background Systemic inflammation as assessed by CRP has been associated with averse events after DES implantation. After PCI, the occurrence of PMI is common and has also been associated with worse outcomes. Finally, bifurcations are frequently encountered anatomically complex lesions which the treatment is associated with higher complication rate compared with simple lesions. Methods A total of 96 patients (66 ± 10 years, 70 men) from the Coronary bifurcations: Application of the Crushing Technique Using Sirolimus-eluting stents (CACTUS) trial who had baseline CRP dosage and both baseline and postprocedural CK-MB measurement were included. Results A complex bifurcation strategy was implemented in 53 (55{\%}) patients, and angiographic success was achieved in all but two (2{\%}) patients. Periprocedural myocardial necrosis (increase of CK-MB between one and three times the upper limit of normal [ULN]) was observed in 12 (13{\%}) patients, and four (4{\%}) patients had PCI-related myocardial infarction (increase of CK-MB more than three times ULN). Notably, progressively higher CRP levels were observed in patients with different increase in CK-MB (P = 0.041). Moreover, CRP >1 mg/L significantly predicted CK-MB rise (odds ratio 5.6, 95{\%} confidence interval 1.5-4.3, P = 0.011). Conclusion In the setting of true coronary bifurcations treated by DES, baseline CRP levels were significantly associated with both the incidence and the extent of PMI. {\circledC} 2013 Wiley Periodicals, Inc.",
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