Effect of early statin and selective cyclooxygenase-2 inhibitor therapy on C-reactive protein level after percutaneous coronary angioplasty in unstable angina.

Aims: We evaluated the effect of cyclooxygenase-2 inhibitor rofecoxib added to atorvastatin, initiated immediately after percutaneous coronary angioplasty (PCI), on C-reactive protein (CRP) and interleukin-6 (IL-6) in patients with unstable angina (UA).

Methods And Results: Sixty patients were prospectively randomized to receive: (A) 10 mg atorvastatin or (B) 40mg atorvastatin or (C) atorvastatin 40 mg plus rofecoxib 12.5 mg. Treatment was continued for 6 months. CRP and IL-6 levels increased within 48 hours after PCI in all groups, in comparison with A and B, a more pronounced decrease in CRP (mg/l) and IL-6 (pg/ml) levels at 3- and 6-month follow-up was present in C: CRP at 6 months: 0.76 vs. 1.92 vs. 0.11, p<0.05; IL-6 at 6 months: 0.02 vs. 0.04 vs. 0.01, p<0.05. At 6-month follow-up the reduction in CRP level occurred in 70% of subjects with CRP higher than median (3.6mg/l) at baseline vs. 15% of patients with CRP lower than median (p<0.041).

Conclusion: After PCI in UA, cyclooxygenase-2 inhibitor rofecoxib added to atorvastatin reduced CRP and IL-6 levels more profoundly than atorvastatin alone at 3- and 6-month after intervention. In the group receiving combined therapy, reduction in CRP levels was more frequently observed in patients with higher CRP at baseline.