High CRP or Lp(a), but not homocysteine, predict adverse events after coronary stenting, a study of 483 patients followed 3 years (J Am Coll Cardiol 2002)

Original title: The impact of plasma levels of C-reactive protein, lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting: The Global Evaluation of New Events and Restenosis After Stent Implantation Study

J Am Coll Cardiol · 16 October 2002 · 7

Zairis MN, Ambrose JA, Manousakis SJ, Stefanidis AS, Papadaki OA, Bilianou HI, DeVoe MC, Fakiolas CN, Pissimissis EG, Olympios CD, Foussas SG, Global Evaluation of New Events and Restenosis After Stent Implantation Study Group

This study followed 483 consecutive patients with stable or unstable coronary syndromes for up to three years after successful coronary stenting, to test whether CRP, Lp(a), or homocysteine predict long-term prognosis. By study end, high CRP (at or above 0.68 mg/dL, P<0.001) or high Lp(a) (at or above 25 mg/dL, P=0.003), but not homocysteine, independently predicted the composite endpoint of cardiac death, myocardial infarction, or rehospitalisation for unstable angina. High CRP also predicted 1-year clinical symptom recurrence (P<0.001) and progression of atherosclerosis to a significant lesion in a non-intervened vessel (P<0.001), but none of the markers predicted in-stent restenosis. The findings show elevated CRP or Lp(a), but not homocysteine, are associated with higher rates of late adverse events after coronary stenting, with disease progression in non-intervened vessels playing a more significant role than in-stent restenosis.

Original abstract

Objectives: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS).

Background: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited.

Methods: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion (<or=50% luminal diameter stenosis) that was located in a nonintervened vessel at restudy, resulting in an angiographically significant lesion (>or=70% luminal diameter stenosis).

Results: By the end of the follow-up, high plasma levels of either CRP or Lp(a) but not tHCY were independently associated with the primary end point. In particular, CRP >or=0.68 mg/dl (p < 0.001) or Lp(a) >or=25 mg/dl (p = 0.003) conferred a significantly increased risk. By 1 year, a CRP >or=0.68 mg/dl conferred a significantly increased risk for clinical recurrence of symptoms (p < 0.001) or PTSL (p < 0.001). None of the studied biochemical markers was related to ISR.

Conclusions: High plasma levels of either CRP or Lp(a) but not tHCY may be associated with a higher incidence of late adverse events after successful CS. PTSL in vessels not previously intervened upon may play a significant role in the underlying pathophysiology as opposed to ISR.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.