Copyright © 2000 by the European Society of Cardiology.
Plasma levels of C-reactive protein after coronary stent implantation
Department of Cardiology, University of Vienna, Vienna, Austria
revised October 12, 1999; accepted October 13, 1999
Abstract
Aims This study was designed to investigate the role of inflammation on the occurrence of angiographic restenosis 6 months after coronary stent implantation and the influence of different kinds of antithrombotic and antiplatelet strategies on inflammation.
Methods and Results In an open randomized trial, 40 consecutive patients were treated with aspirin (100mg.day–1) and either ticlopidine (2x250mg.day–1) (n=17), or phenprocoumon (INR 2·0–3·0) and dipyridamole (3x160mg.day–1) (n=23) after successful elective coronary stent implantation. Plasma levels of C-reactive protein were determined one day before stent implantation and serially thereafter twice daily up to 120h. C-reactive protein plasma levels increased significantly (P<0·0001) after stent implantation. Phenprocoumon and dipyridamole or ticlopidine had no effect on C-reactive protein plasma levels (P=0·51) or the occurrence of angiographic restenosis (P=0·48). C-reactive protein plasma levels were significantly higher in patients with lesion type C compared to types A or B (P=0·035), respectively. C-reactive protein plasma levels were significantly higher and mean shoulder levels occurred 48h later in patients with restenosis compared to patients without restenosis after 6 months (P=0·038).
Conclusions Elevated C-reactive protein plasma levels still persisting 96h after stent implantation might reflect a prolonged inflammatory reaction to coronary stent implantation which might causally be involved in pathophysiological mechanisms leading to restenosis.
Key Words: Coronary artery disease, coronary stent, inflammation, C-reactive protein
f1 Correspondence: Dr Michael Gottsauner-Wolf, Department of Cardiology, Clinic for Internal Medicine II, Allgemeines Krankenhaus Wien, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
References
- Nobuyoshi M, Kimura T, Nosaka H. Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. J Am Coll Cardiol. 1988;12:616–623[Abstract]
- Gottsauner-Wolf M, Moliterno DJ, Lincoff AM, Topol EJ. Restenosis—an open file. Clin Cardiol. 1996;19:347–356[ISI][Medline]
- Fischman DL, Leon ML, Baim DS. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496–501
[Abstract/Free Full Text] - Serruys P, de Jaegere P, Kiemeniej F. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994;331:489–495
[Abstract/Free Full Text] - Schomig A, Neumann FJ, Kastrati A. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents. N Engl J Med. 1996;334:1084–1089
[Abstract/Free Full Text] - Kastrati A, Schühlen H, Hausleiter J. Restenosis after coronary stent placement and randomization to a 4 week combined antiplatelet or anticoagulant therapy. Six-month angiographic follow-up of the Intracoronary Stenting and Antithrombotic Regimen (ISAR) Trial. Circulation. 1997;96:462–467
- Huber K, Jörg M, Probst P. A decrease in plasminogen activator inhibitor-1 activity after successful percutaneous transluminal coronary angioplasty is associated with a significantly reduced risk for coronary restenosis. Thromb Haemostas. 1992;67:209–213[ISI][Medline]
- N Engl J Med. 1994;330:956–961
[Abstract/Free Full Text] - Faxon DP, Sanborn TA, Haudenschild CC, Ryan TJ. Effect of antiplatelet therapy on restenosis after experimental angioplasty. Am J Cardiol. 1984;53:72C–76C[CrossRef][Medline]
- Fingerle J, Muller RMK, Kuhn H, Pech M, Baumgartner HR. Mechanism of inhibition of neointimal formation by the angiotensin-converting enzyme inhibitor Cilazapril: A study in balloon catheter-injured rat carotid arteries. Arterioscler Thromb Vasc Biol. 1995;15:1945–1950
[Abstract/Free Full Text] - Currier JP, Pow TK, Minihan AC, Haudenschild CC, Faxon DP, Ryan TJ. Colchicin inhibits restenosis after iliac angioplasty in the atherosclerotic rabbit. Circulation. 1989;80:II–66
- Villa A, Guzman L, Chen W, Golomb G, Levy R, Topol E. Local delivery of dexamethasone for prevention of neointimal proliferation in a rat model of balloon angioplasty. J Clin Invest. 1994;93:1243–1249[ISI][Medline]
- Circulation. 1992;86:100–110
[Abstract/Free Full Text] - O'Keefe JHJ, McCallister BD, Bateman TM, Kuhnlein DL, Ligon RW, Hartzler GO. Ineffectiveness of colchicine for the prevention of restenosis after coronary angioplasty. J Am Coll Cardiol. 1992;19:1597–1600[Abstract]
- Pepine CJ, Hirshfeld JW, MacDonald RG. A controlled trial of corticosteroids to prevent restenosis after coronary angioplasty. Circulation. 1990;81:1753–1761
[Abstract/Free Full Text] - Liuzzo G, Buffon A, Biasucci LM. Enhanced inflammatory response to coronary angioplasty in patients with severe unstable angina. Circulation. 1998;98:2370–2376
[Abstract/Free Full Text] - Bazzino O, Diaz R, Tajer C. Clinical predictors of in-hospital prognosis in unstable angina: ECLA 3. The ECLA Collaborative Group. Am Heart J. 1999;137:322–331[CrossRef][ISI][Medline]
- Ridker PM, Cushman M, Stampfer MJ, Tracy RP, Hennekens CH. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med. 1997;336:973–979
[Abstract/Free Full Text] - Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med. 1995;332:635–641
[Abstract/Free Full Text] - Haverkate F, Thompson SG, Pyke SD, Gallimore JR, Pepys MB. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet. 1997;349:462–466[CrossRef][ISI][Medline]
- Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC. C reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. Br Med J. 1996;312:1061–1065
[Abstract/Free Full Text] - Ryan TJ, Faxon DP, Gunnar RM. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation. 1988;78:486–502
[Free Full Text] - Reiber JHC, Serruys PW, Kooijman CJ. Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. Circulation. 1985;71:280–288
[Abstract/Free Full Text] - Gottsauner-Wolf M, Sochor H, Mörtl D. Assessing coronary stenosis: quantitative coronary angiography versus visual estimation from cine-film or pharmacologic stress perfusion images. Eur Heart J. 1996;17:1167–1174
[Abstract/Free Full Text] - Kuller LH, Tracy RP, Shaten J, Meilahn EN. Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. Am J Epidemiol. 1996;144:537–547
[Abstract/Free Full Text] - Liuzzo G, Biasucci LM, Gallimore J. The prognostic value of C-reactive protein and serum amyloid a protein in severe unstable angina. N Engl J Med. 1994;331:417–424
[Abstract/Free Full Text] - Tracy RP, Lemaitre RN, Psaty BM. Relationship of C-reactive protein to risk of cardiovascular disease in the elderly. Results from the Cardiovascular Health Study and the Rural Health Promotion Project. Arterioscler Thromb Vasc Biol. 1997;17:1121–1127
[Abstract/Free Full Text] - Fuster V, Falk E, Fallon JT, Badimon L, Chesebro JH, Badimon JJ. The three processes leading to post PTCA restenosis: Dependence on the lesion substrate. Thromb Haemost. 1995;74:552–559[ISI][Medline]
- Pietersma A, Kofflard M, de Wit LE. Late lumen loss after coronary angioplasty is associated with the activation status of circulating phagocytes before treatment. Circulation. 1995;91:1320–1325
[Abstract/Free Full Text] - van Beusekom HM, van der Giessen WJ, van Suylen R, Bos E, Bosman FT, Serruys PW. Histology after stenting of human saphenous vein bypass grafts: observations from surgically excised grafts 3 to 320 days after stent implantation. J Am Coll Cardiol. 1993;21:45–54[Abstract]
- Jang Y, Lincoff AM, Plow EF, Topol EJ. Cell adhesion molecules in coronary artery disease. J Am Coll Cardiol. 1994;24:1591–1601[Abstract]
- Fischman DL, Leon MB, Baim DS. A randomized comparison of stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496–501
[Abstract/Free Full Text] - Cohen DJ, Krumholz HM, Sukin CA. In-hospital and one-year economic outcomes after coronary stenting or balloon angioplasty: Results from a randomized clinical trial. Circulation. 1995;92:2480–2487
[Abstract/Free Full Text]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  S. R. Steinhubl, J. J. Badimon, D. L. Bhatt, J.-M. Herbert, and T. F. Luscher Clinical evidence for anti-inflammatory effects of antiplatelet therapy in patients with atherothrombotic disease Vascular Medicine, May 1, 2007; 12(2): 113 - 122. [Abstract] [PDF]
|
|
|
|
 |
|
 W. J. Gomes and E. Buffolo Coronary stenting and inflammation: implications for further surgical and medical treatment. Ann. Thorac. Surg., May 1, 2006; 81(5): 1918 - 1925. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Herrmann Peri-procedural myocardial injury: 2005 update Eur. Heart J., December 1, 2005; 26(23): 2493 - 2519. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. Inoue, T. Kato, T. Uchida, M. Sakuma, A. Nakajima, M. Shibazaki, Y. Imoto, M. Saito, S. Hashimoto, Y. Hikichi, et al. Local Release of C-Reactive Protein From Vulnerable Plaque or Coronary Arterial Wall Injured by Stenting J. Am. Coll. Cardiol., July 19, 2005; 46(2): 239 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Toutouzas, A. Colombo, and C. Stefanadis Inflammation and restenosis after percutaneous coronary interventions Eur. Heart J., October 1, 2004; 25(19): 1679 - 1687. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J.-J. Li, C.-H. Fang, H. Jiang, C.-X. Hunag, Q.-Z. Tang, X.-H. Wang, and G.-S. Li Increased C-Reactive Protein Level After Renal Stent Implantation in Patients with Atherosclerotic Renal Stenosis Angiology, September 1, 2004; 55(5): 479 - 484. [Abstract] [PDF]
|
|
|
|
 |
|
 D. A. Morrow Preprocedural C-Reactive Protein for Risk Prediction Before Percutaneous Coronary Intervention (PCI): A US Perspective Clin. Chem., September 1, 2004; 50(9): 1489 - 1491. [Full Text] [PDF]
|
|
|
|
 |
|
 J R S Day, I S Malik, A Weerasinghe, M Poullis, I Nadra, D O Haskard, K M Taylor, and R C Landis Distinct yet complementary mechanisms of heparin and glycoprotein IIb/IIIa inhibitors on platelet activation and aggregation: implications for restenosis during percutaneous coronary intervention Heart, July 1, 2004; 90(7): 794 - 799. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Segev, S. Kassam, C. E Buller, H. K Lau, J. D Sparkes, P. W Connelly, P. H Seidelin, M. K Natarajan, E. A Cohen, and B. H Strauss Pre-procedural plasma levels of C-reactive protein and interleukin-6 do not predict late coronary angiographic restenosis after elective stenting Eur. Heart J., June 2, 2004; 25(12): 1029 - 1035. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Exner, M. Schillinger, E. Minar, W. Mlekusch, S. Sabeti, G. Endler, M. Raith, C. Mannhalter, and O. Wagner Interleukin-6 Promoter Genotype and Restenosis after Femoropopliteal Balloon Angioplasty: Initial Observations Radiology, June 1, 2004; 231(3): 839 - 844. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schillinger, M. Exner, E. Minar, W. Mlekusch, M. Mullner, C. Mannhalter, F. H. Bach, and O. Wagner Heme oxygenase-1 genotype and restenosis after balloon angioplasty: a novel vascular protective factor J. Am. Coll. Cardiol., March 17, 2004; 43(6): 950 - 957. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M Backes, P. A Howard, and P. M Moriarty Role of C-Reactive Protein in Cardiovascular Disease Ann. Pharmacother., January 1, 2004; 38(1): 110 - 118. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. J. Pearce and J. F. McKinsey Current Status of Intravascular Stents as Delivery Devices to Prevent Restenosis Vascular and Endovascular Surgery, July 1, 2003; 37(4): 231 - 237. [Abstract] [PDF]
|
|
|
|
|
|
M. Schillinger, M. Exner, W. Mlekusch, H. Rumpold, R. Ahmadi, S. Sabeti, W. Lang, O. Wagner, and E. Minar Acute-Phase Response after Stent Implantation in the Carotid Artery: Association with 6-month In-Stent Restenosis Radiology, May 1, 2003; 227(2): 516 - 521. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schillinger, M. Exner, W. Mlekusch, H. Rumpold, R. Ahmadi, S. Sabeti, M. Haumer, O. Wagner, and E. Minar Vascular Inflammation and Percutaneous Transluminal Angioplasty of the Femoropopliteal Artery: Association with Restenosis Radiology, October 1, 2002; 225(1): 21 - 26. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Schillinger, M. Exner, W. Mlekusch, M. Haumer, R. Ahmadi, H. Rumpold, O. Wagner, and E. Minar Inflammatory Response to Stent Implantation: Differences in Femoropopliteal, Iliac, and Carotid Arteries Radiology, August 1, 2002; 224(2): 529 - 535. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.J. Blake and P.M. Ridker C-reactive protein and prognosis after percutaneous coronary intervention Eur. Heart J., June 2, 2002; 23(12): 923 - 925. [Full Text] [PDF]
|
|
|
|
 |
|
 D. P. Chew, D. L. Bhatt, M. A. Robbins, M. S. Penn, J. P. Schneider, M. S. Lauer, E. J. Topol, and S. G. Ellis Incremental Prognostic Value of Elevated Baseline C-Reactive Protein Among Established Markers of Risk in Percutaneous Coronary Intervention Circulation, August 28, 2001; 104(9): 992 - 997. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Lincoff, D. J. Kereiakes, M. A. Mascelli, L. I. Deckelbaum, E. S. Barnathan, K. K. Patel, B. Frederick, M. T. Nakada, and E. J. Topol Abciximab Suppresses the Rise in Levels of Circulating Inflammatory Markers After Percutaneous Coronary Revascularization Circulation, July 10, 2001; 104(2): 163 - 167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. Wijns and F. Ribichini CRP: does it stand for C oronary R estenosis P rediction? Eur. Heart J., July 2, 2000; 21(14): 1121 - 1123. [PDF]
|
|
|
|
|
|
A. W. Chan, D. L. Bhatt, D. P. Chew, M. J. Quinn, D. J. Moliterno, E. J. Topol, and S. G. Ellis Early and Sustained Survival Benefit Associated With Statin Therapy at the Time of Percutaneous Coronary Intervention Circulation, February 12, 2002; 105(6): 691 - 696. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||