Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Circ Cardiovasc Interv. 2009 Dec;2(6):513-8. doi: 10.1161/CIRCINTERVENTIONS.109.889915. Epub 2009 Oct 13.
Percutaneous coronary intervention (PCI) using drug-eluting stents significantly reduces the risk of restenosis in the general population. However, in patients on hemodialysis, adverse cardiac events are frequently seen even if treated with drug-eluting stents. Recent studies suggest that C-reactive protein (CRP) reflects vascular wall inflammation and can predict adverse cardiac events. We evaluated possible prognostic values of CRP on outcomes in patients on hemodialysis undergoing PCI with drug-eluting stents.
A total of 167 patients undergoing PCI with sirolimus-eluting stents for stable angina (322 lesions) were enrolled. They were divided into tertiles according to serum CRP levels. We analyzed the incidence of major adverse cardiovascular events including cardiovascular death, nonfatal myocardial infarction, and target lesion revascularization after PCI as well as quantitative coronary angiographic data. The mean follow-up was 31 months (SD, 14). Major adverse cardiac events occurred in 11 patients (19.6%) of the lowest tertile, in 22 patients (39.3%) of the middle tertile, and in 28 patients (50.9%) of the highest tertile during follow-up period (P=0.0009). There was a progressive increase in neointimal growth after sirolimus-eluting stent implantation during follow-up because preprocedural CRP levels were higher, despite similar angiographic data just after PCI. Angiographic restenosis at 6 to 8 months after PCI was seen in 10.6% in the lowest tertile, 17.9% in the middle tertile, and 32.0% in the highest tertile (P=0.0007).
Increased preprocedural serum CRP levels would predict higher major adverse cardiac events and restenosis rates after sirolimus-eluting stents implantation in patients on hemodialysis.
经皮冠状动脉介入治疗（PCI）使用药物洗脱支架可显著降低普通人群的再狭窄风险。然而，即使在接受药物洗脱支架治疗的血液透析患者中，也经常发生不良心脏事件。最近的研究表明，C 反应蛋白（CRP）反映血管壁炎症，可预测不良心脏事件。我们评估了 CRP 对接受药物洗脱支架 PCI 的血液透析患者预后的可能预测价值。
共纳入 167 例接受西罗莫司洗脱支架治疗稳定型心绞痛（322 处病变）的患者。根据血清 CRP 水平将其分为三分位。我们分析了 PCI 后主要不良心血管事件（包括心血管死亡、非致死性心肌梗死和靶病变血运重建）的发生率以及定量冠状动脉造影数据。平均随访 31 个月（标准差，14 个月）。在随访期间，最低三分位组有 11 例（19.6%）、中间三分位组有 22 例（39.3%）和最高三分位组有 28 例（50.9%）发生主要不良心脏事件（P=0.0009）。尽管 PCI 后即刻的血管造影数据相似，但由于支架植入前 CRP 水平较高，在随访期间仍观察到西罗莫司洗脱支架植入后的新生内膜生长逐渐增加。在 PCI 后 6 至 8 个月时，最低三分位组的血管造影再狭窄率为 10.6%，中间三分位组为 17.9%，最高三分位组为 32.0%（P=0.0007）。
血液透析患者支架植入前血清 CRP 水平升高预示着西罗莫司洗脱支架植入后发生主要不良心脏事件和再狭窄的风险增加。
