We sought to evaluate the impact of
C-reactive protein (CRP) levels on in-
stent restenosis after
percutaneous coronary intervention.The plasma level of CRP is considered a risk predictor for
cardiovascular diseases. However, the relationship between CRP and in-
stent restenosis has been a matter of controversy. Meta-analysis reduces variability and better evaluates the correlation.We performed a systemic search for literature published in March 2008 and earlier, using MEDLINE(R), the Cochrane clinical trials database, and EMBASE(R). We also scanned relevant reference lists and hand-searched all review articles or abstracts from conference reports on this topic. Of the 245 studies that we initially searched, we chose 9 prospective observational studies (1,062 patients).Overall, CRP concentration was higher in patients who experienced in-
stent restenosis. The weighted mean difference in CRP levels between the patients with in-
stent restenosis and those without was 1.67, and the Z-score for overall effect was 2.12 (P=0.03). Our subgroup analysis that compared patients with stable and
unstable angina showed a weighted mean difference in the CRP levels of 2.22 between the patients with and without in-
stent restenosis, and the Z-score for overall effect was 2.23 (P=0.03) in 5 studies of
unstable-angina patients. There was no significance in 4 studies of
stable-angina patients.In spite of significant heterogeneity across the studies, our meta-analysis suggests that preprocedurally elevated levels of CRP are associated with greater in-
stent restenosis after stenting and that this impact appears more prominent in
unstable-angina patients.