Comparison of C-Reactive Protein Levels After Coronary Stenting With Bare Metal Versus Sirolimus- Eluting Stents Jose M. de la Torre-Hernandez, MD, PhD, Fermin Sainz-Laso, MD, Virginia Burgos, MD, Teresa Perez, MD, Alvaro Figueroa, MD, PhD, Javier Zueco, MD, and Thierry Colman, MD We evaluated C-reactive protein increases after im- plantation of bare metal stents in 200 patients and sirolimus-eluting stents in 100 patients. The magni- tude of change in C-reactive protein was comparable between groups. Clinical follow-up showed a relation between the postprocedural C-reactive protein in- crease and outcome that was significant in the bare metal stent group, which accounted for the most of events, but not in the sirolimus-eluting stent group. 2005 by Excerpta Medica Inc. (Am J Cardiol 2005;95:748 –751) I ncreased C-reactive protein (CRP) after percutane- ous coronary intervention has been described in patients who have unstable and stable angina pectoris, with a greater increase in patients who do not have diabetes and a lesser increase in those who receive glycoprotein IIb/IIIa inhibitors. 1–6 The clinical signif- icance of this inflammatory response has been evalu- ated in previous studies that have found some relation to clinical outcome and angiographic restenosis. 7–9 Nevertheless, the small sample of 40 to 81 patients 7–9 or lack of clinical follow up 1–5 prevented any mean- ingful prognostic conclusion to be drawn about the effect of increased CRP. Sirolimus-eluting stents (SESs) have demonstrated dramatic decreases in the incidence of restenosis. 10,11 The objectives of our study were to (1) assess changes in CRP level after implanting bare metal stent (BMS) and SESs and (2) evaluate the prognostic implications of changes in CRP. ••• Patients who underwent coronary stenting in our institution were included unless they met 1 of the following exclusion criteria: very low ejection fraction (30%), severe heart failure or cardiogenic shock, intra-aortic counterpulsation balloon pump, recent Q or non–Q myocardial infarction (14 days), signifi- cant renal failure (creatinine 2 mg/dl), and compli- cations (cardiac, vascular access site, or systemic) during or 24 hours after the procedure. Sera were collected from all patients immediately before the procedure through an arterial sheath (before administration of unfractionated heparin) to measure levels of creatine kinase, creatine kinase-MB, troponin I, and CRP. Blood samples were obtained from all patients 8 and 20 hours after the procedure to measure levels of creatine kinase, creatine kinase-MB, troponin I, CRP, and creatinine. CRP was measured with a high sensitivity test, the Dimension clinical chemistry sys- tem with Flex reagents (Dade Behring, Inc., Deerfield, Illinois), which is a turbidimetric immunoassay with latex particles covered with anti-CRP antibody. The value that is the upper limit of normal for CRP in our laboratory is 0.3 mg/dl. CRP increases after percuta- neous coronary intervention were calculated as the difference between the 20-hour and basal levels. Cre- atine kinase-MB was measured with an Access crea- tine kinase-MB assay (Beckman Coulter Inc., Brea, California), and troponin I was measured with the high-sensitivity assay Access AccuTnI (Beckman Coulter Inc.) using a cut-off value of 0.5 ng/ml to diagnose myocardial necrosis. An increase in troponin I after percutaneous coronary intervention was defined as a postprocedural value 0.5 ng/ml above normal basal levels or an increased value in patients who had abnormal but decreasing basal levels of troponin I. A femoral artery access site was used in all pa- tients. The use of SES or BMS was determined by an operator whose decision was based mostly on lesion profile (in general, lesions with higher restenosis risk were managed with SES). All stents implanted in every patient were of the same type, i.e., all BMSs or all SESs. Abciximab administration was left to the operator’s discretion but was used more frequently in patients who had unstable angina and those who had diabetes and complex lesions. Successful and uncomplicated percutaneous coro- nary intervention was defined as (1) postprocedural stenosis 25% and normal flow and (2) no vascular, even transient, complications during the procedure and no clinical complications for 24 hours after the procedure. Angiographic analysis, including lesion morphology and stenotic severity, were assessed vi- sually by 2 different observers. These 2 observers were blinded to the laboratory results. A diffuse lesion was defined as being 20 mm in length, and a small vessel was defined as a 2.5 mm reference diameter. To collect clinical events during follow-up, pa- tients were required to visit the clinical cardiology office 4 to 6 and 12 months after the procedure. Major cardiac adverse events were defined as cardiac death, From the Interventional Cardiology Department and the Division of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Spain. Dr. de la Torre-Hernandez’s address is: Unidad de Hemodi- namica y Cardiologia Intervencionista, Hospital Universitario Marqués de Valdecilla, Avenida Valdecilla s/n, 39008 Santander, Spain. E-mail: hemodinamica@humv.es. Manuscript received July 28, 2004; revised manuscript received and accepted November 11, 2004. 748 ©2005 by Excerpta Medica Inc. All rights reserved. 0002-9149/05/$–see front matter The American Journal of Cardiology Vol. 95 March 15, 2005 doi:10.1016/j.amjcard.2004.11.027