Renal dysfunction and high levels of hsCRP are additively associated with hard endpoints after percutaneous coronary intervention with drug eluting stents.

BACKGROUND: Chronic kidney disease (CKD) and high C-reactive protein (CRP) are known risk factors of cardiovascular disease. In the drug eluting stent (DES) era, the relationship among CKD, CRP, and long-term outcomes after percutaneous coronary intervention (PCI) has not yet been demonstrated. We investigated the combined effects of renal dysfunction and CRP on outcomes in patients who underwent PCI using DES. METHODS: A total of 1859 patients (mean age 64 ± 10 years) who underwent PCI with DES between February 2003 and June 2006, were divided into 4 groups (quartile) according to estimated glomerular filtration rate (eGFR) and hsCRP at admission. RESULTS: The composite of cumulative death and non-fatal myocardial infarction (mortality+MI) during median follow-up of 27 months, was significantly higher in the lowest eGFR quartile than in the other three groups (hazard ratio (HR) for mortality+MI: 3.32, 95% CI: 2.21-5.00, P<0.001). Mortality+MI was also significantly higher in the highest hsCRP quartile (HR: 3.29, 95% CI: 2.02-5.37, P<0.001). A combined analysis of mortality+MI on the basis of hsCRP and renal function showed the exaggerated hazard in the combined worst quartile of hsCRP and GFR (HR of the combined worst quartile, 10.876, 95% CI: 3.74-31.63, P<0.001). Furthermore, both the lowest eGFR quartile and the highest hsCRP quartile were significantly associated with increased risk of stent thrombosis. In a multivariate analysis, low GFR and high hsCRP were independent predictors of mortality+MI after PCI with DES along with left ventricular dysfunction, diabetes, and left main disease. CONCLUSIONS: In an unselected cohort of patients receiving PCI with DES, poor renal function and high hsCRP were additively associated with a higher risk of hard endpoints and were independent predictors of mortality+MI even after correction for other factors. Our data suggest the importance of systemic factors on mortality even in the DES era.

Physiologic assessment of jailed side branch lesions using fractional flow reserve.

OBJECTIVES: This study was performed to evaluate the feasibility of the physiologic assessment of jailed side branches using fractional flow reserve (FFR) and to compare the measured FFR with the stenosis severity assessed by quantitative coronary angiography (QCA). BACKGROUND: It is not well-known which side branches should be treated after stent implantation at main branches and how to assess the functional significance of these lesions. METHODS: Ninety-seven jailed side branch lesions (vessel size > 2.0 mm, percent stenosis > 50% by visual estimation) after stent implantation at main branches were consecutively enrolled. The FFR was measured using a pressure wire at 5 mm distal and proximal to the ostial lesion of the jailed side branch. RESULTS: The FFR measurement was successful in 94 lesions. Mean FFRs were 0.94 +/- 0.04 and 0.85 +/- 0.11 at the main branches and jailed side branches, respectively. There was a negative correlation between the percent stenosis and FFR (r = -0.41, p < 0.001). However, no lesion with < 75% stenosis had FFR < 0.75. Among 73 lesions with > or = 75% stenosis, only 20 lesions were functionally significant. CONCLUSIONS: The FFR measurement in jailed side branch lesions is both safe and feasible. Quantitative coronary angiography is unreliable in the assessment of the functional severity of jailed side branch lesions, and measurement of FFR suggests that most of these lesions do not have functional significance.