C-reactive protein and myocardial infarction during percutaneous coronary intervention

Objective. To evaluate the prognostic information of preprocedural C-reactive protein (CRP) levels in serum to predict myocardial infarction during percutaneous coronary interventions (PCI). Design. Prospective study. Setting. University hospital. Patients. A total of 400 consecutive patients with normal serum troponin T levels (less than or equal to0.03 mug L-1) presenting with stable or unstable angina pectoris. Interventions. PCI. Main outcome measures. C-reactive protein levels in serum measured by a high sensitive method. Myocardial infarction defined as a serum troponin T elevation the day after PCI to a level >0.05 mug L-1. Results. Eighty-three patients (21%) experienced a myocardial infarction during PCI. The median value of CRP before the procedure was 1.83 (0.12-99.7) mg L-1. No difference was seen in CRP levels before PCI between patients without or with myocardial infarction during PCI. Multivariate analysis identified stent implantation (OR 2.68, 95% CI 1.18-7.28, P = 0.03), procedure time (OR 2.15, 95% CI 1.28-3.67, P < 0.005) and complications during the procedure (OR 3.62, 95% CI 1.72-7.58, P < 0.001) as independent predictors of myocardial infarction during PCI. Conclusion. Increased CRP levels in serum before PCI were not associated with myocardial infarction during the procedure. Furthermore, patients with an expected long procedure and a high probability of stent implantation have an increased risk of developing myocardial infarction during PCI. This finding may be useful to help the operator to decide the antithrombotic regime before, during and after the procedure and the need for observation after the procedure.