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Impact of high-sensitivity C-reactive protein on coronary artery disease severity and outcomes in patients undergoing
1Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
Insights
High-sensitivity C-reactive protein (hs-CRP) levels correlate with coronary artery disease (CAD) severity. While elevated hs-CRP indicates greater disease burden, it does not independently predict long-term adverse cardiovascular events after percutaneous coronary intervention.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Inflammation is central to coronary artery disease (CAD) pathogenesis.
- Large-scale data on high-sensitivity C-reactive protein (hs-CRP) and CAD severity are limited.
- Understanding the relationship between hs-CRP and CAD outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the association between hs-CRP levels and CAD severity.
- To evaluate the impact of hs-CRP on long-term outcomes in patients undergoing percutaneous coronary intervention (PCI).
- To assess hs-CRP as a potential biomarker for risk stratification in CAD patients.
Main Methods:
- A large cohort of 10,020 patients undergoing PCI were analyzed.
- Patients were stratified into three groups based on admission hs-CRP levels (0-3mg/L, 3.01-10mg/L, >10mg/L).
- Coronary artery disease severity was assessed using the SYNTAX score (SS); major adverse cardiovascular events (MACEs) were tracked during follow-up.
Main Results:
- Elevated hs-CRP levels were associated with older age, more comorbidities, and higher SYNTAX scores.
- hs-CRP >10mg/L was an independent predictor of intermediate-high SS (>22).
- While elevated hs-CRP correlated with increased MACEs, death, and revascularization rates, it was not an independent predictor of adverse outcomes in multivariate analysis.
Conclusions:
- Serum hs-CRP is a valuable biomarker for reflecting CAD severity.
- hs-CRP can aid in the initial risk stratification of patients with coronary artery disease.
- SYNTAX score remains a strong independent predictor of MACEs and revascularization post-PCI.
Background:
Inflammation plays a pivotal role in coronary artery disease (CAD). Few data from large-size studies are available on the association of high-sensitivity C-reactive protein (hs-CRP) and severity of CAD. Our aim was to investigate their relationship as well as their impact on long-term outcomes in patients undergoing percutaneous coronary intervention.
Methods:
In 2013, 10,020 patients were consecutively included. Patients were divided into three groups based on hs-CRP on admission: 0-3mg/L (n=6978, 69.6%), 3.01-10mg/L (n=1997, 19.9%), >10mg/L (n=1045, 10.4%). Disease severity was determined by SYNTAX score (SS). Their differences were assessed in SS and major adverse cardiovascular events (MACEs, including all-cause death, myocardial infarction, revascularization, and in-stent thrombosis) among groups.
Results:
The mean follow-up period was 874 days. Patients with elevated hs-CRP were older, had more risk factors such as hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, and cigarette smoking. Multivariate regression analysis showed that hs-CRP >10mg/L (OR 1.49, 95% confidence interval 1.21-1.84, p<0.001), age, previous myocardial infarction, serum creatinine, and left ventricular ejection fraction were independent predictors of intermediate-high SS (>22). Subgroup analysis indicated that the relation between hs-CRP and SS was also consistent in acute coronary syndrome and its subtypes. Although elevated hs-CRP was positively associated with increased rates of MACEs (11.0% versus 12.1% versus 14.3%, p=0.006), death (1.0% versus 1.3% versus 3.0%, p<0.001), and revascularization (8.6% versus 10.4% versus 10.0%, p=0.032), it did not show any prognostic effect for adverse outcomes in multivariate regression analyses (all adjusted p> 0.05). While SS>22 remained independently predictive of MACEs and revascularization after adjusting confounders, the risks of which were increased by 56% and 68%, respectively.
Conclusion:
Serum hs-CRP could be a useful biomarker for indicating CAD severity and could aid in risk stratification.
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