Pre-procedural C-reactive protein levels and clinical outcomes after percutaneous coronary interventions with and without abciximab: pooled analysis of four ISAR trials

Heart. 2009 Feb;95(2):107-12. doi: 10.1136/hrt.2008.153635. Epub 2008 Sep 18.


Objective: To assess the prognostic value of the baseline C-reactive protein (CRP) level in patients undergoing percutaneous coronary intervention (PCI) after pre-treatment with 600 mg of clopidogrel and whether there is an interaction between CRP level and abciximab in terms of outcome.

Design: Pooled analysis from the ISAR-SWEET, SMART-2, ISAR-REACT and REACT-2 trials. SETTING, METHODS: The study included 4847 patients with coronary artery disease (CAD) undergoing PCI after pre-treatment with 600 mg of clopidogrel. The primary outcome was one-year mortality. The combined incidence of death, myocardial infarction and target lesion revascularisation was the secondary outcome.

Results: Based on the median value of CRP (2.3 mg/l), patients were divided into two groups: the high-CRP group (n = 2448) and the low-CRP group (n = 2399). During one year, there were 141 deaths (5.8%) in the high-CRP group compared with 51 deaths (2.1%) in the low-CRP group (OR = 2.77, 95% CI 2.04 to 3.77; p<0.001). The incidence of major adverse cardiac events (MACE) was 28% in the high-CRP group compared with 25% in the low-CRP group (OR = 1.13, 95% CI 1.01 to 1.26; p = 0.034). The Cox proportional hazards model showed that high CRP was an independent predictor of one-year mortality (hazard ratio 2.20, 95% CI 1.54 to 3.15; p<0.001 for CRP level >2.3 mg/l vs CRP level < or =2.3 mg/l). No significant interaction was observed between CRP level and abciximab regarding one-year mortality (p = 0.08) or MACE (p = 0.68).

Conclusion: In patients with CAD undergoing PCI after pretreatment with 600 mg of clopidogrel, baseline CRP level predicts one-year mortality and MACE. Abciximab therapy did not confer any particular beneficial effect in patients with a higher inflammatory burden.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abciximab
  • Aged
  • Angioplasty, Balloon, Coronary*
  • Antibodies, Monoclonal / therapeutic use*
  • Biomarkers / blood
  • C-Reactive Protein / metabolism*
  • Clopidogrel
  • Coronary Disease / mortality
  • Coronary Disease / therapy*
  • Female
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use*
  • Male
  • Multicenter Studies as Topic
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Preoperative Care
  • Prognosis
  • Randomized Controlled Trials as Topic
  • Ticlopidine / analogs & derivatives*
  • Ticlopidine / therapeutic use


  • Antibodies, Monoclonal
  • Biomarkers
  • Immunoglobulin Fab Fragments
  • Platelet Aggregation Inhibitors
  • C-Reactive Protein
  • Clopidogrel
  • Ticlopidine
  • Abciximab