Published Online
on October 13, 2009

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Original Article

Prognostic Values of C-Reactive Protein Levels on Clinical Outcome After Implantation of Sirolimus-Eluting Stents in Patients on Hemodialysis

Hideki Ishii, MD, PhD; Takanobu Toriyama, MD, PhD; Toru Aoyama, MD, PhD; Hiroshi Takahashi, BSc; Tetsuya Amano, MD, PhD; Mutsuharu Hayashi, MD, PhD; Miho Tanaka, MD; Yoshihiro Kawamura, MD; Yoshinari Yasuda, MD, PhD; Yukio Yuzawa, MD, PhD; Shoichi Maruyama, MD, PhD; Seiichi Matsuo, MD, PhD; Tatsuaki Matsubara, MD, PhD and Toyoaki Murohara, MD, PhD

From the Department of Cardiology (H.I., T. Amano, M.H., T. Murohara), Nagoya University Graduate School of Medicine; Cardiolovascular Center (H.I., T.T., T. Aoyama, H.T., M.T., Y.K.), Nagoya Kyoritsu Hospital; Department of Clinical Immunology (Y. Yasuda, Y. Yuzawa, S. Maruyama, S. Matsuo), Nagoya University Graduate School of Medicine; and Department of Internal Medicine (T. Matsubara), School of Dentistry Aichi-Gakuin University, Nagoya, Japan.

Correspondence to Hideki Ishii, MD, PhD, Department of Cardiology, Nagoya University Graduate School of Medicine, 65, Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. E-mail hkishii{at}med.nagoya-u.ac.jp

Background—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.

Methods and Results—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).

Conclusions—Increased preprocedural serum CRP levels would predict higher major adverse cardiac events and restenosis rates after sirolimus-eluting stents implantation in patients on hemodialysis.

Key Words: kidney • follow-up studies • prognosis • stents • inflammation