Time-dependent changes of hs-CRP serum concentration in patients with non-ST elevation acute coronary syndrome
Jürgen Jahn1, Inke Hellmann, Matthias Maass
1Department of Internal Medicine, Borromäus Hospital, Leer, Germany. jahn@borro-leer.de
Insights
Follow-up high-sensitivity C-reactive protein (hs-CRP) levels can identify patients with coronary artery disease (CAD) at high risk for future cardiac events. A decrease in hs-CRP indicates a better prognosis, while elevated levels suggest persistent inflammation and increased event risk.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Atherosclerosis is linked to low-grade vascular inflammation, measurable by highly sensitive C-reactive protein (hs-CRP).
- Acute coronary syndromes (ACS) are associated with inflammatory plaque rupture.
- Assessing follow-up hs-CRP levels in coronary artery disease (CAD) patients is valuable.
Purpose of the Study:
- To evaluate the prognostic value of serial hs-CRP measurements in patients with ACS.
- To determine if hs-CRP changes over time correlate with future cardiac events.
- To identify a potential hs-CRP threshold for risk stratification in CAD.
Main Methods:
- 133 patients admitted with ACS had hs-CRP measured on admission and at 6 months.
- Cardiac events were tracked for 6 months and 3 years.
- A questionnaire was used for the 3-year follow-up assessment.
Main Results:
- hs-CRP levels significantly decreased from baseline (3.9 mg/l) to follow-up (2.9 mg/l) in the overall cohort.
- Patients without cardiac events showed a significant hs-CRP decrease, while those with events had persistently elevated levels.
- A follow-up hs-CRP level >60% of the initial level predicted a 3.4-fold increased risk of future cardiac events.
Conclusions:
- A decrease in hs-CRP levels after 6 months in non-ST elevation ACS patients without early events suggests a favorable prognosis.
- Elevated follow-up hs-CRP levels, particularly above 60% of baseline, identify patients at high risk for subsequent cardiac events.
- Repeated hs-CRP measurements may aid in stratifying risk and guiding management in CAD patients.
Background:
Atherosclerosis is typically associated with a low-grade vascular inflammation that can be measured with the highly sensitive C-reactive protein (hs-CRP) assay. Actually, acute coronary syndromes are thought to result from plaque rupture which is induced by the inflammatory process in the atherosclerotic tissue. Therefore, it is interesting to discuss the value of follow-up measurements of hs-CRP in patients with coronary artery disease (CAD).
Patients And Methods:
The hs-CRP concentration of 133 patients consecutively admitted with an acute coronary syndrome (ACS) was measured on admission and after 6 months. The final assessment after 3 years was structured by questionnaire.
Results:
17 cardiac events occurred within 6 months, 30 during the following 3 years. The hs-CRP levels (median +/- SEM) decreased significantly (p < 0.001) from baseline (3.9 +/- 1.3 mg/l) to follow-up (2.9 +/- 0.9 mg/l). Subdivision according to cardiac events during the first observation period confirmed this decrease in patients without events (baseline: 3.9 +/- 1.5 mg/l, follow-up: 2.9 +/- 0.9 mg/l; p < 0.001), whereas patients with events showed a persistent elevation (baseline: 3.8 +/- 0.9 mg/l, follow-up: 4.1 +/- 1.0 mg/l; p = 0.426). Patients who developed a further event during the 6-month period showed hs-CRP levels at follow-up that were > 60% of the initial level. Interestingly, 80% of the events within the following 3 years occurred in patients with an hs-CRP level above this discriminator. With a follow-up hs-CRP value above this discriminator the relative risk of suffering an event was 3.4 (95% confidence interval 1.27-8.9; p < 0.05).
Conclusion:
Patients with a non-ST elevation ACS who showed no event within 6 months are characterized by a decrease in hs-CRP levels from baseline to follow-up. Most events in the observation period of 3 years occurred in patients with follow-up hs-CRP levels > 60% of the initial level. Therefore, it was hypothesized that a repeated measurement of hs-CRP levels in CAD patients could help to discriminate those at high risk of further events.
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