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Comparative prognostic value of C-reactive protein & fibrinogen in patients with coronary artery disease
Gjin Ndrepepa1, Siegmund Braun, Tomohisa Tada
1German Heart Centre, Technical University, Munich, Germany.
Insights
C-reactive protein (CRP) is a superior predictor of mortality in coronary artery disease (CAD) patients compared to fibrinogen. Elevated CRP levels independently correlate with increased all-cause mortality risk in this population.
Area of Science:
- Cardiology
- Biomarkers
- Prognostic Medicine
Background:
- The comparative prognostic value of C-reactive protein (CRP) and fibrinogen for cardiovascular events remains incompletely understood.
- Investigating these inflammatory markers is crucial for refining risk stratification in patients with coronary artery disease (CAD).
Purpose of the Study:
- To directly compare the prognostic capabilities of C-reactive protein (CRP) and fibrinogen in predicting mortality among patients diagnosed with coronary artery disease (CAD).
Main Methods:
- A cohort of 13,100 patients with confirmed coronary artery disease (CAD) underwent plasma CRP and fibrinogen level measurements prior to coronary angiography.
- Elevated levels were defined as CRP >3 mg/l and fibrinogen >350 mg/dl.
- The primary endpoint assessed was 1-year all-cause mortality.
Main Results:
- Patients were stratified into four groups based on CRP and fibrinogen levels, with significant differences in 1-year mortality observed (P<0.001).
- Multivariate analysis identified elevated CRP levels as an independent correlate of mortality (adjusted HR=1.31, 95% CI 1.18-1.45).
- Fibrinogen levels did not demonstrate an independent association with mortality in the multivariate analysis (adjusted HR=0.99, 95% CI 0.90-1.09).
Conclusions:
- C-reactive protein (CRP) serves as a more potent predictor of mortality in patients with coronary artery disease (CAD) than fibrinogen.
- CRP provides prognostic information that extends beyond conventional cardiovascular risk factors, aiding in risk assessment.
Background & Objectives:
The comparative prognostic value of C-reactive protein (CRP) and fibrinogen for cardiovascular events has been inconclusively investigated. t0 his study was carried out to compare the prognostic value of CRP versus fibrinogen in patients with coronary artery disease (CAD).
Methods:
The study included 13,100 patients with coronary angiography-confirmed CAD. Plasma CRP and fibrinogen levels were measured before angiography in all patients. The levels of CRP>3 mg/l and fibrinogen>350 mg/dl were considered as elevated. The primary outcome was 1-year all-cause mortality.
Results:
Patients were divided into four groups: patients with CRP≤3 mg/l and fibrinogen ≤350 mg/dl (n=4206); patients with CRP≤3 mg/l and fibrinogen >350 mg/dl (n=3132); patients with CRP>3 mg/l and fibrinogen ≤ 350 mg/dl (n=1273) and CRP >3 mg/l and patients with fibrinogen >350 mg/dl (n=4489). There were 634 deaths: 75 deaths in patients with CRP ≤3 mg/l and fibrinogen ≤350 mg/dl, 91 deaths in patients with CRP ≤3 mg/l and fibrinogen >350 mg/dl, 87 deaths in patients with CRP >3 mg/l and fibrinogen ≤350 mg/dl and 381 deaths in patients with CRP >3 mg/l and fibrinogen >350 mg/dl (Kaplan-Meier estimates of all-cause mortality, 1.8, 3.0, 7.0 and 8.7 %, log-rank test P<0.001). The multivariate analysis showed that CRP [adjusted hazard ratio (HR)=1.31, 95% confidence interval (CI) 1.18-1.45, for each standard deviation increase in the logarithmic scale] but not fibrinogen [adjusted HR=0.99 (0.90-1.09), for each standard deviation increase in the logarithmic scale] was an independent correlate of mortality.
Interpretation & Conclusions:
The findings indicated that in patients with CAD, CRP was a better predictor of mortality than fibrinogen and offered prognostic information beyond that provided by the conventional cardiovascular risk factors.
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