Relationship between baseline inflammatory markers, antiplatelet therapy, and adverse cardiac events after percutaneous coronary intervention: An analysis from the clopidogrel for the reduction of events during observation trial

Kristofer Dosh, Peter B. Berger, Steven Marso, Fredrick Van Lente, Danielle M. Brennan, Richard Charnigo, Eric J. Topol, Steven Steinhubl

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Background - We evaluated patients undergoing percutaneous coronary intervention to assess the predictive value of high-sensitivity C-reactive protein (hs-CRP) and pregnancy-associated plasma protein-A (PAPP-A) on adverse cardiac outcomes and the effect of antiplatelet therapy on these outcomes. Methods and Results - Baseline blood samples were available on 1468 CREDO (Clopidogrel for the Reduction of Events During Observation) patients for hs-CRP testing and 1096 patients for PAPP-A testing. The 1-year primary end point was the composite incidence of death, myocardial infarction, or stroke. Patients in the highest 2 tertiles of hs-CRP had more events compared with the lowest tertile (11.4% versus 6.4%, P=0.003). Treatment with clopidogrel reduced the 1-year composite end point for patients in the highest 2 tertiles of hs-CRP (9.1% clopidogrel versus 13.5% placebo, P=0.04) but not in the lowest tertile. Elevated PAPP-A levels were associated with a trend toward more events at 1 year that did not reach statistical significance. Patients in the highest 2 tertiles of PAPP- randomized to clopidogrel had fewer events (7.3% clopidogrel versus 13.1% placebo, P=0.01), but no benefit was seen in the lowest tertile. A 46% risk reduction with randomization to clopidogrel was seen in patients in the highest 2 tertiles of both biomarkers (8.7% versus 16.2%, P=0.02). Conclusions - Patients undergoing nonurgent percutaneous coronary intervention who have elevated hs-CRP and PAPP-A have an increased incidence of adverse cardiovascular events. The clinical benefit of adding clopidogrel to aspirin seems greater in those with increased levels of these inflammatory biomarkers.

Original languageEnglish (US)
Pages (from-to)503-512
Number of pages10
JournalCirculation: Cardiovascular Interventions
Volume2
Issue number6
DOIs
StatePublished - Dec 2009

Fingerprint

clopidogrel
Percutaneous Coronary Intervention
Observation
Pregnancy-Associated Plasma Protein-A
C-Reactive Protein
Therapeutics
LY 165163
Biomarkers
Placebos
Incidence
Risk Reduction Behavior
Random Allocation
Aspirin

Keywords

  • Blood platelets
  • Catheterization
  • Coronary disease
  • Inflammation
  • Pharmaceutical preparations

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relationship between baseline inflammatory markers, antiplatelet therapy, and adverse cardiac events after percutaneous coronary intervention : An analysis from the clopidogrel for the reduction of events during observation trial. / Dosh, Kristofer; Berger, Peter B.; Marso, Steven; Lente, Fredrick Van; Brennan, Danielle M.; Charnigo, Richard; Topol, Eric J.; Steinhubl, Steven.

In: Circulation: Cardiovascular Interventions, Vol. 2, No. 6, 12.2009, p. 503-512.

Research output: Contribution to journalArticle

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abstract = "Background - We evaluated patients undergoing percutaneous coronary intervention to assess the predictive value of high-sensitivity C-reactive protein (hs-CRP) and pregnancy-associated plasma protein-A (PAPP-A) on adverse cardiac outcomes and the effect of antiplatelet therapy on these outcomes. Methods and Results - Baseline blood samples were available on 1468 CREDO (Clopidogrel for the Reduction of Events During Observation) patients for hs-CRP testing and 1096 patients for PAPP-A testing. The 1-year primary end point was the composite incidence of death, myocardial infarction, or stroke. Patients in the highest 2 tertiles of hs-CRP had more events compared with the lowest tertile (11.4{\%} versus 6.4{\%}, P=0.003). Treatment with clopidogrel reduced the 1-year composite end point for patients in the highest 2 tertiles of hs-CRP (9.1{\%} clopidogrel versus 13.5{\%} placebo, P=0.04) but not in the lowest tertile. Elevated PAPP-A levels were associated with a trend toward more events at 1 year that did not reach statistical significance. Patients in the highest 2 tertiles of PAPP- randomized to clopidogrel had fewer events (7.3{\%} clopidogrel versus 13.1{\%} placebo, P=0.01), but no benefit was seen in the lowest tertile. A 46{\%} risk reduction with randomization to clopidogrel was seen in patients in the highest 2 tertiles of both biomarkers (8.7{\%} versus 16.2{\%}, P=0.02). Conclusions - Patients undergoing nonurgent percutaneous coronary intervention who have elevated hs-CRP and PAPP-A have an increased incidence of adverse cardiovascular events. The clinical benefit of adding clopidogrel to aspirin seems greater in those with increased levels of these inflammatory biomarkers.",
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AU - Berger, Peter B.

AU - Marso, Steven

AU - Lente, Fredrick Van

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AU - Charnigo, Richard

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AU - Steinhubl, Steven

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AB - Background - We evaluated patients undergoing percutaneous coronary intervention to assess the predictive value of high-sensitivity C-reactive protein (hs-CRP) and pregnancy-associated plasma protein-A (PAPP-A) on adverse cardiac outcomes and the effect of antiplatelet therapy on these outcomes. Methods and Results - Baseline blood samples were available on 1468 CREDO (Clopidogrel for the Reduction of Events During Observation) patients for hs-CRP testing and 1096 patients for PAPP-A testing. The 1-year primary end point was the composite incidence of death, myocardial infarction, or stroke. Patients in the highest 2 tertiles of hs-CRP had more events compared with the lowest tertile (11.4% versus 6.4%, P=0.003). Treatment with clopidogrel reduced the 1-year composite end point for patients in the highest 2 tertiles of hs-CRP (9.1% clopidogrel versus 13.5% placebo, P=0.04) but not in the lowest tertile. Elevated PAPP-A levels were associated with a trend toward more events at 1 year that did not reach statistical significance. Patients in the highest 2 tertiles of PAPP- randomized to clopidogrel had fewer events (7.3% clopidogrel versus 13.1% placebo, P=0.01), but no benefit was seen in the lowest tertile. A 46% risk reduction with randomization to clopidogrel was seen in patients in the highest 2 tertiles of both biomarkers (8.7% versus 16.2%, P=0.02). Conclusions - Patients undergoing nonurgent percutaneous coronary intervention who have elevated hs-CRP and PAPP-A have an increased incidence of adverse cardiovascular events. The clinical benefit of adding clopidogrel to aspirin seems greater in those with increased levels of these inflammatory biomarkers.

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