Biological profiles in subjects with recurrent acute coronary events compared with subjects with long-standing stable
P Bogaty1, P Poirier, S Simard
1Quebec Heart Institute/Laval Hospital, Laval University, Ste-Foy, Quebec, Canada.
Insights
An inflammatory profile, including C-reactive protein (CRP), distinguishes patients with multiple acute coronary events from those with stable angina. Elevated CRP levels predict future acute coronary events in coronary artery disease patients.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Coronary artery disease (CAD) presents a spectrum from stable angina to recurrent acute ischemic events.
- Distinguishing these clinical extremes and predicting acute events is clinically significant.
Purpose of the Study:
- To test if a specific biological profile differentiates patients with multiple acute coronary events from those with long-standing stable angina.
- To determine if this profile predicts future acute coronary events.
Main Methods:
- Comparison of blood biomarkers including lipoprotein(a), homocysteine, tissue plasminogen activator, plasminogen activator inhibitor-1, C-reactive protein (CRP), fibrinogen, and von Willebrand factor.
- Three groups studied: multiple acute events, stable angina (>3 years), and healthy controls.
- Follow-up for 4.0 years to monitor acute coronary events.
Main Results:
- Lipoprotein(a), homocysteine, t-PA, and PAI-1 were similar in CAD groups but higher than controls.
- CRP, fibrinogen, and von Willebrand factor were significantly higher in the multiple acute events group compared to the stable angina group.
- Acute coronary events (myocardial infarction, unstable angina) occurred in 42% of the multiple events group vs. 4% of the stable angina group.
- Multivariate analysis identified CRP as the sole significant predictor of follow-up acute events (OR 5.9).
- A baseline CRP >3.5 mg/L conferred a 7.6-fold increased risk for subsequent acute events.
Conclusions:
- An inflammatory biological profile differentiates patients with a history of multiple acute coronary events from those with long-standing stable angina.
- Elevated C-reactive protein (CRP) is a key marker distinguishing these groups and predicts future acute coronary instability.
Background:
At one end of the clinical spectrum of coronary artery disease (CAD) are subjects who have had repeated acute ischemic events, and at the other end are those with long-standing angina who have never been unstable. This study tests the hypothesis that a specific biological profile can distinguish these 2 extreme groups and predict acute coronary events.
Methods And Results:
Blood levels of lipoprotein(a), homocysteine, tissue plasminogen activator, plasminogen activator inhibitor-1, C-reactive protein (CRP), fibrinogen, and von Willebrand factor were compared in 3 groups of 50 subjects each: (1) those with previous multiple acute coronary events, (2) age-matched subjects with >/=3 years of stable angina and no prior acute coronary events, and (3) matched controls without evidence of atherosclerotic disease and a normal coronary angiogram. All subjects were followed for 4.0 years. Lipoprotein(a), homocysteine, tissue plasminogen activator, and plasminogen activator inhibitor-1 were similar in both CAD groups and significantly higher than in the control group. However, compared with subjects with long-standing stable angina, those with previous multiple coronary events had higher values of CRP (5.7+/-5.4 versus 3.0+/-5.2 mg/L, P=0.012), fibrinogen (3.38+/-0.75 versus 2.92+/-0.64 g/L, P=0.001), and von Willebrand factor (1.60+/-0.55 versus 1.25+/-0.36 U/mL, P=0.0003). On follow-up, myocardial infarction and unstable angina occurred in 42% of the group with multiple events, 4% of the stable angina group (P<0.0001), and none of the control subjects. In the 100 patients with CAD, CRP was 4.9 mg/L in those with and 1.8 mg/L in those without new instability (P<0.0001). In a multivariate analysis, only CRP distinguished those with follow-up acute coronary events (adjusted odds ratio 5.9, 95% CI 2.0 to 17.9; P=0.002). A baseline CRP >3.5 mg/L had a relative risk of 7.6 (2.6 to 21.7, P=0.0002) for subsequent acute events.
Conclusions:
An inflammatory biological profile distinguished patients with previous multiple acute coronary events from those with long-standing stable angina and predicted acute coronary instability.
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