Letter to the Editor One month follow-up C-reactive protein may be a useful predictor of angiographic restenosis and long-term clinical outcomes after bare metal stent implantation Joo-Yong Hahn, Hyo-Soo Kim * , Bon-Kwon Koo * , Sang-Hoon Na, Joong-Wha Chung, Tae-Jin Youn, Woo-Young Chung, In-Ho Chae, Dong-Ju Choi, Byung-Hee Oh, Myoung-Mook Lee, Young-Bae Park Department of Internal Medicine, Seoul National University College of Medicine, Cardiovascular Laboratory, Clinical Research Institute, Korea Cardiovascular Center, Seoul National University Hospital, Seoul, Korea Received 30 March 2005; accepted 1 April 2005 Available online 10 May 2005 Abstract We report C-reactive protein (CRP) measured 1 month after stenting was an independent predictor of angiographic restenosis, and patients with both elevated preprocedural CRP and CRP 1 month after stenting had the worst long-term clinical outcomes. Measurement of CRP during follow-up in addition to preprocedural CRP may improve risk stratification after coronary stenting. D 2005 Elsevier Ireland Ltd. All rights reserved. Keywords: C-reactive protein; Stent; Restenosis Elevated preprocedural CRP (CRP pre ) levels have been shown to be independently predictive of restenosis and cardiovascular events after coronary stent implantation, [1] and persistently elevated CRP levels for more than 48 h after procedure have been shown to be associated with an increased risk of restenosis [2]. However, CRP levels before and shortly after procedure do not reflect the most active stage of restenosis after stenting, which has been demon- strated to peak between 1 and 3 months in angiographical follow-up study [3]. Therefore, CRP levels between 1 and 3 months may have more important implications in predicting restenosis and adverse cardiac events than CRP levels before and shortly after coronary stenting. This study was conducted to investigate the predictive value of CRP levels measured 1 month after procedure (CRP 1month ) in regard to the risk of angiographic restenosis at 6 months and long-term major adverse cardiac events (MACEs) after coronary stenting. We performed successful implantation of bare metal stent and 6-month angiographic follow-up in 89 patients. CRP levels were measured before and 1 month after procedure by a commercially available kit (CRP-Latex (II) X2, Denka Seiken, Japan; measuring range 0.1 – 320 mg/L). Patients were evaluated clinically up to 3 years. MACEs were defined as death, non-fatal myocardial infarction (MI), and target lesion revascularization (TLR). Levels of CRP 1month were elevated (>3 mg/L) in 27 patients (30%). Clinical parameters did not differ according to CRP 1month level except that males were more common in patients with elevated levels of CRP 1month ( p = 0.02) (Table 1). Although procedural and angiographic parameters before and immediately after coronary stenting were not significant different according to the level of CRP 1month , follow-up angiographic data showed that patients with elevated CRP 1month had a greater late lumen loss (1.23 T 0.74 mm vs. 0.77 T 0.65 mm, p = 0.004) and greater loss index (64 T 35% vs. 38 T 30%, p = 0.001) than those with normal CRP 1month . The cumulative frequency distribution curve of percentage stenosis showed a rightward shift at follow-up in 0167-5273/$ - see front matter D 2005 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2005.04.015 * Corresponding authors. Tel.: +82 2 2072 2226; fax: +82 2 766 8904. E-mail address: hyosoo@snu.ac.kr (H.-S. Kim), bkkoo@snu.ac.kr (B.-K. Koo). International Journal of Cardiology 109 (2006) 267 – 269 www.elsevier.com/locate/ijcard