Preprocedural serum levels of acute-phase reactants and prognosis after percutaneous coronary intervention.

OBJECTIVE: In this study we evaluate the value of baseline concentrations of acute-phase reactants on prognosis after percutaneous coronary intervention (PCI). METHODS: Blood samples were drawn immediately before PCI to measure baseline concentrations of C-reactive protein (CRP), interleukin-6 (IL-6), lipoprotein(a) (Lp(a)), and fibrinogen. Follow-up data were collected at 8 months. Repeat PCI, CABG, myocardial infarction, and death were recorded as major adverse clinical events (MACE). Furthermore the recurrence of angina pectoris was noted. RESULTS: The study included 600 consecutive patients after a successful PCI. Sixty-four percent of the patients were stented. The mean age was 61.6 years and 68.9% were male. CRP levels were significantly higher in patients who were to have repeat angina as compared with those who were not (P=0.0322). IL-6 levels were not correlated with angina or MACE. Lp(a) and fibrinogen concentrations were both significantly related to MACE (P=0.0337 and P=0.0253, respectively). CONCLUSION: Our study clearly supports the role of inflammation in restenosis after PCI as measured in statistically higher levels of Lp(a) and fibrinogen in patients with MACE and CRP in patients with repeat angina.

Cytomegalovirus and Chlamydia pneumoniae as predictors for adverse events and angina pectoris after percutaneous coronary intervention.

BACKGROUND: The aim of our study was to investigate the influence of prior cytomegalovirus (CMV) or Chlamydia pneumoniae (CP) infection on prognosis after percutaneous coronary intervention (PCI). METHODS: Using the enzyme-linked immunosorbent assay technique preprocedural anti-CMV immunoglobulin G and anti-CP immunoglobulin A (CP IgA), immunoglobulin M, and immunoglobulin G antibodies were measured. Repeat anginal complaints and major adverse clinical events (MACE), including PCI, coronary artery bypass grafting, myocardial infarction, and death, were recorded at 8-month follow-up. RESULTS: Six hundred consecutive patients were included after successful PCI. Sixty-four percent of the patients were stented. The mean age was 61.6 years, and 68.9% were male. The rate of seropositivity for CP IgA in patients with MACE as compared with patients without MACE was 50.9% versus 35.4% (P =.0276). In patients with repeat anginal complaints, CP IgA seropositivity was 41.6% versus 34.6% in patients without repeat angina (P =.1057). The negative effect of CP on prognosis was confirmed after calculating the odds ratios for MACE (1.9, 95% CI 1.1-3.3). The rates of seropositivity for anti-CMV immunoglobulin G were not significantly different between both groups, although we found an association between infectious burden and repeat angina pectoris (odds ratio 1.8, 95% CI 1.1-3.0). CONCLUSIONS: We conclude that preprocedural seropositivity of CP IgA is a risk factor for MACE and angina pectoris after PCI. Although no such relation was found for CMV alone, the cumulative infectious burden was also related to these clinical manifestations of restenosis.