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Published on: January 28, 2020
High-sensitivity C-reactive protein predicts 10-year cardiovascular outcome after percutaneous coronary intervention
Rohit M Oemrawsingh1, Jin M Cheng, K Martijn Akkerhuis
1Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
Insights
High-sensitivity C-reactive protein (hsCRP) measured during percutaneous coronary intervention (PCI) predicts 10-year mortality and myocardial infarction risk. Elevated hsCRP levels improve risk assessment in PCI patients.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
- Assessing long-term prognosis after PCI remains crucial for patient management.
- Inflammatory markers may offer additional prognostic information beyond traditional risk factors.
Purpose of the Study:
- To evaluate the prognostic value of high-sensitivity C-reactive protein (hsCRP) in patients undergoing PCI.
- To determine if hsCRP levels predict 10-year mortality or myocardial infarction after PCI.
- To assess the utility of hsCRP in refining risk stratification in PCI patients.
Main Methods:
- A cohort of 468 patients undergoing PCI with sirolimus-eluting stents were analyzed.
- High-sensitivity C-reactive protein (hsCRP) was measured at the time of PCI.
- The primary endpoint was a composite of all-cause mortality or myocardial infarction at 10-year follow-up.
- Cox regression analysis was used to adjust for cardiovascular risk factors.
Main Results:
- Higher hsCRP levels were significantly associated with an increased risk of the composite endpoint at 10 years.
- Patients with hsCRP >3 mg/L had a 2.87-fold increased risk (HR 2.87, 95% CI: 1.69-4.87) compared to those with <1 mg/L.
- While not significantly improving model discrimination, hsCRP enhanced risk classification (NRI=0.40, p<0.001).
Conclusions:
- Elevated hsCRP levels at the time of PCI are predictive of 10-year mortality and myocardial infarction.
- High-sensitivity C-reactive protein serves as a valuable biomarker for improving risk assessment in patients undergoing PCI.
- Incorporating hsCRP into risk models can aid in better stratifying PCI patient outcomes.
Aims:
This study aimed to evaluate the prognostic value of high-sensitivity C-reactive protein (hsCRP) during 10-year follow-up after percutaneous coronary intervention (PCI).
Methods And Results:
Between April and October 2002, hsCRP was measured in 468 all-comer patients who underwent PCI with sirolimus-eluting stent implantation for stable coronary artery disease or acute coronary syndrome. The primary endpoint was the composite of all-cause mortality or myocardial infarction at 10-year follow-up. Kaplan-Meier event curves displayed ongoing divergence of the hsCRP groups (hsCRP <1 mg/L: 14.7% vs. 1-3 mg/L: 31.1% vs. >3 mg/L: 43.1%). After adjustment for established cardiovascular risk factors and clinical presentation in a Cox regression model, higher CRP levels were associated with a higher incidence of the composite endpoint (>3 mg/L vs. <1 mg/L: HR 2.87, 95% CI: 1.69-4.87, p<0.001; 1-3 mg/L vs. <1 mg/L: HR 2.30, 95% CI: 1.31-4.03, p=0.004). Although adding hsCRP to a prediction model containing conventional cardiovascular risk factors did not significantly improve discriminatory power (area under the receiver operating characteristic curve 0.71 to 0.73, p=0.56), hsCRP was able to improve risk classification (net reclassification index=0.40, p=<0.001).
Conclusions:
In patients undergoing PCI, higher CRP levels at the time of the procedure are predictive for 10-year mortality and myocardial infarction. High-sensitivity CRP may be a useful biomarker to improve further risk assessment in patients undergoing PCI.
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