Preprocedural C-Reactive Protein for Risk Prediction Before Percutaneous Coronary Intervention (PCI): a European Perspective (Editorials‪)‬

Percutaneous coronary intervention (PCI) with stent implantation is a mainstay in the management of severe coronary artery atherosclerotic disease. Indeed, PCI currently outperforms coronary artery bypass grafting, and the use of interventional procedures is projected to increase even more with the adoption of new-generation drug-eluting stents (1). Even when performed by the best operators and with the most recent technologies, however, PCI may be fraught by significant short- and long-term risks of adverse events (1). Two major processes are involved in adverse events following PCI: (a) coronary restenosis, and (b) progression of disease on the same vessel or in another vessel (2). The latter is central to the understanding of ischemic heart disease and to its primary and secondary prevention, and has been addressed in numerous studies. On the other hand, the long-term outlook after PCI can be affected by neo-intimal proliferation at the site of PCI, leading to in-stent restenosis, recurrent angina, and ultimately, target-lesion revascularization (3). In this issue, Rittersma et al. (4) address specifically the issue of in-stent restenosis. Although restenosis is a decreasing problem with the use of drug-eluting stents, the cost of these devices is high, and in most European countries only a minority of stents are drug-eluting, making prediction of restenosis a still-hot clinical and biological problem.