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Diagnosis and Assessment

Schoos MM, Kelbæk H, Kofoed KF et al.  Am J Cardiol 2011;107:1597–603.

This study showed that high-sensitivity C-reactive protein measured during primary percutaneous coronary intervention in patients suffering from ST-segment elevation myocardial infarction is predictive of adverse outcome. In addition, the presented findings suggest that the choice of either drug-eluting stent or bare-metal stent might be best made based on the inflammatory status of the patient.

 

Complicated clinical outcomes after percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) include in-stent thrombosis, recurrent STEMI, and death. Inflammation may play a pivotal role in initiating and maintaining processes leading to these complications. The present study was a post hoc analysis of the DEDICATION (Drug Elution and Distal Protection in Acute MI) trial [1], a randomized controlled trial that was originally designed to evaluate whether implantation of a drug-eluting stent (DES) reduces neointimal proliferation in the infarct-related lesion, and thereby improves clinical outcome compared with bare-metal stents (BMS) in an unselected group of patients with STEMI. A total of 301 patients from one of the participating DEDICATION centers were included in the current analysis. In these patients, blood samples for high-sensitivity C-reactive protein (hs-CRP) measurement were drawn just before PCI was performed. As expected, hs-CRP proved to be an independent predictor of death and all non-fatal recurrent MIs (hazard ratio [HR] 2.7, 95% confidence interval [CI] 1.3–5.6) at a 36-month follow-up, as were age (HR 1.045 per year, 95% CI 1.016–1.075) and multivessel coronary disease (HR 2.1, 95% CI 1.4–3.2). Notably, when applying a clinical relevant hs-CRP cut-off of >2 mg/mL, significant differences for occurrence of death and recurrent myocardial infarction were seen: 4.8% for those with BMS and low hs-CRP, 11.9% in the DES and low hs-CRP (≤2 mg/L) group, 17.6% for those with DES and high hs-CRP, and 27.9% in the BMS and low hs-CRP group. These findings indicate that when selecting either BMS or DES for PCI in STEMI, the inflammatory status of the patient might be worth considering, since BMS seems to have the most favorable outcome in low-inflammatory patients, while DES is associated with favorable outcome in patients with high hs-CRP levels. Importantly, since this was a post hoc analysis and not the primary study outcome, several relevant biases might be present. Therefore, the results of this study cannot be extrapolated for use in daily practice before proper confirmation of the main findings is accomplished.

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