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A Sensitive and Specific Quantitation Method for Determination of Serum Cardiac Myosin Binding Protein-C by Electrochemiluminescence Immunoassay
Published on: August 8, 2013
Incremental prognostic value of elevated baseline C-reactive protein among established markers of risk in
D P Chew1, D L Bhatt, M A Robbins
1Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
Insights
Elevated C-reactive protein before percutaneous coronary intervention indicates a higher risk of death or myocardial infarction within 30 days. Combining inflammatory markers with clinical factors improves risk prediction for patients undergoing coronary procedures.
Area of Science:
- Cardiology
- Inflammation and Cardiovascular Disease
- Interventional Cardiology
Background:
- Traditional percutaneous coronary intervention (PCI) risk assessment relies on clinical and anatomical factors.
- Growing evidence highlights the significant role of inflammation in coronary artery disease outcomes.
- Inflammatory markers may offer additional prognostic information beyond established risk predictors.
Purpose of the Study:
- To assess the association of baseline C-reactive protein (CRP) with 30-day adverse events after PCI.
- To evaluate the predictive value of CRP in conjunction with existing clinical and angiographic risk factors.
- To determine if incorporating CRP improves risk stratification models for PCI patients.
Main Methods:
- Analysis of a single-center registry of 727 patients undergoing percutaneous coronary revascularization.
- Assessment of baseline C-reactive protein levels prior to PCI.
- Evaluation of the association between CRP levels and the composite endpoint of death or myocardial infarction within 30 days.
- Development and validation of a predictive model incorporating CRP, lesion characteristics, and clinical presentation.
Main Results:
- Elevated baseline C-reactive protein was associated with a significantly increased risk of 30-day death or myocardial infarction (highest vs. lowest quartile: 14.2% vs. 3.9%, P=0.002).
- Baseline CRP independently predicted adverse events, with the highest quartile showing an odds ratio of 3.68 (95% CI, 1.51 to 8.99; P=0.004).
- A predictive model including CRP, lesion score, acute coronary syndrome, and stenting demonstrated strong predictive utility (C-statistic, 0.735).
Conclusions:
- Elevated baseline C-reactive protein is a significant predictor of heightened 30-day risk following coronary intervention.
- Integrating inflammatory markers like CRP with anatomic and clinical data enhances risk stratification accuracy.
- This combined approach may aid in guiding therapeutic strategies for patients undergoing PCI.
Background:
Established methods of risk assessment in percutaneous coronary intervention have focused on clinical and anatomical lesion characteristics. Emerging evidence indicates the substantial contribution of inflammatory processes to short-term and long-term outcomes in coronary artery disease.
Methods And Results:
Within a single-center registry of contemporary percutaneous coronary revascularization strategies with postprocedural creatine kinase and clinical events routinely recorded, we assessed the association of baseline C-reactive protein with death or myocardial infarction within the first 30 days. Predictive usefulness of baseline C-reactive protein within the context of established clinical and angiographic predictors of risk was also examined. Among 727 consecutive patients, elevated baseline C-reactive protein before percutaneous coronary intervention was associated with progressive increase in death or myocardial infarction at 30 days (lowest quartile, 3.9%, versus highest quartile, 14.2%; P=0.002). Among clinical and procedural characteristics, baseline C-reactive protein remained independently predictive of adverse events, with the highest quartile of C-reactive protein associated with an odds ratio for excess 30-day death or myocardial infarction of 3.68 (95% CI, 1.51 to 8.99; P=0.004). A predictive model that included baseline C-reactive protein quartiles, American College of Cardiology/American Heart Association lesion score, acute coronary syndrome presentation, and coronary stenting appears strongly predictive of 30-day death or myocardial infarction within this population (C-statistic, 0.735) and among individual patients (Brier score, 0.006).
Conclusions:
Elevated baseline C-reactive protein portends heightened risk of 30-day death or myocardial infarction after coronary intervention. Coupled anatomic, clinical, and inflammatory risk stratification demonstrates strong predictive utility among patients undergoing percutaneous coronary intervention and may be useful for guiding future strategies.
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