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Inflammatory Protein Levels and Depression Screening After Coronary Stenting Predict Major Adverse Coronary Events

School of Nursing, Texas Heart Institute at St. Luke's Episcopal Hospital Houston, Texas, Lorraine.Frazier{at}uth.tmc.edu

William K. Vaughn, PhD

Texas Heart Institute at St. Luke's Episcopal Hospital Houston, Texas

James T. Willerson, MD

Texas Heart Institute at St. Luke's Episcopal Hospital Houston, Texas, Department of Internal Medicine

Christie M. Ballantyne, MD

School of Public Health The University of Texas Health Science Center at Houston, Houston, Texas, Methodist DeBakey Heart Center and Baylor College of Medicine Houston, Texas

Eric Boerwinkle, PhD

Texas Heart Institute at St. Luke's Episcopal Hospital Houston, Texas

Background: Traditional risk factors cannot account for the majority of future major adverse coronary events (MACE) in patients diagnosed with heart disease. We examined levels of inflammatory proteins to be possible predictors of future MACE and physiological and psychological factors that initiate temporal increases in inflammatory protein levels. Methods: Peripheral blood samples and depression data were collected 4 to 12 hr after elective coronary stent insertion in 490 patients. Depression screening was assessed by a single-question screening tool. Predictive modeling for future MACE was performed by using survival analysis, with time from the index event (placement of the stent) to future MACE as the dependent variable. Results: Patients with high-sensitivity c-reactive protein (hsCRP) in the second and third quartiles were 3 and 2.5 times more likely to have a MACE than patients with hsCRP in the first quartile, respectively. As levels of vascular cell adhesion molecule and monocyte chemoattractant protein-1 increased, so did the risk of future MACE. Patients who screened positive for depression were approximately 2 times more likely to have a MACE within 24 months after stent placement than were patients who did not screen positive. Conclusions: Our results suggest that hsCRP, vascular cell adhesion molecule, and monocyte chemoattractant protein-1 levels, measured after coronary stent insertion in patients with coronary heart disease, are prognostic of future MACE. Furthermore, positive depression screening is an independent predictor of future MACE.

Key Words: depression • inflammation • cardiovascular outcome • inflammatory proteins • coronary stents

This version was published on October 1, 2009

Biological Research For Nursing, Vol. 11, No. 2, 163-173 (2009)
DOI: 10.1177/1099800409332801


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