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Prognostic Impact of High-Sensitivity C-Reactive Protein in Patients Undergoing Percutaneous Coronary Intervention
Niklas Beyhoff1, Davide Cao2, Roxana Mehran3
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Insights
Elevated high-sensitivity C-reactive protein (hsCRP) is more common in patients with higher body mass index (BMI) undergoing percutaneous coronary intervention (PCI). hsCRP remains a significant predictor of major adverse cardiac events across all BMI categories.
Area of Science:
- Cardiology
- Biomarkers
- Public Health
Background:
- Elevated high-sensitivity C-reactive protein (hsCRP) is a known predictor of adverse outcomes following percutaneous coronary intervention (PCI).
- The influence of body mass index (BMI) on the prognostic value of hsCRP in PCI patients is not well understood.
Purpose of the Study:
- To investigate the prevalence of elevated hsCRP in patients undergoing PCI, stratified by BMI.
- To determine the prognostic significance of elevated hsCRP for major adverse cardiac events (MACE) in relation to BMI.
Main Methods:
- Analysis of data from 14,140 patients who underwent PCI.
- Patients were categorized into four BMI groups: normal, overweight, obese, and severely obese.
- hsCRP levels (>3 mg/l) and 1-year MACE rates (death, myocardial infarction, target vessel revascularization) were assessed.
Main Results:
- The prevalence of elevated hsCRP increased progressively with higher BMI categories (18.9% to 47.7%).
- Patients with elevated hsCRP consistently experienced higher MACE rates across all BMI groups (p < 0.01).
- Multivariate analysis confirmed hsCRP elevation as an independent predictor of MACE, irrespective of BMI (HRs ranging from 1.43 to 1.92; p < 0.05).
Conclusions:
- hsCRP elevation prevalence rises with increasing BMI in patients undergoing PCI.
- hsCRP measurement is valuable for prognostic risk assessment of adverse outcomes post-PCI across diverse BMI ranges.
Objectives:
The aim of this study was to determine the prevalence and prognostic implications of elevated high-sensitivity C-reactive protein (hsCRP) in patients undergoing percutaneous coronary intervention (PCI) according to body mass index (BMI).
Background:
Whereas elevated hsCRP predicts adverse clinical outcome after PCI in the general population, the impact of BMI on its prognostic utility remains unclear.
Methods:
Data from 14,140 patients who underwent PCI between January 2009 and June 2017 at a large tertiary care center were analyzed. Patients were divided into 4 BMI categories: normal (BMI 18.5 to <25 kg/m2, n = 2,808), overweight (BMI 25 to <30 kg/m2, n = 6,015), obese (BMI 30 to <35 kg/m2, n = 3,490), and severely obese (BMI ≥35 kg/m2, n = 1,827). Elevated hsCRP was defined as >3 mg/l. The primary endpoint of interest was the occurrence of major adverse cardiac events (MACE; defined as death, myocardial infarction, or target vessel revascularization) within 1 year after PCI.
Results:
Elevated hsCRP was present in 18.9%, 23.6%, 33.3%, and 47.7% of the normal, overweight, obese, and severely obese groups, respectively. MACE rates were consistently higher in patients with elevated hsCRP across all BMI categories (normal, 13.4% vs. 8.3%; overweight, 11.2% vs. 7.2%; obese, 10.6% vs. 7.5%; severely obese, 11.9% vs. 6.5%; p < 0.01 for all). After multivariate adjustment, hsCRP elevation remained significantly associated with MACE independent of BMI (hazard ratios: normal, 1.43 [95% confidence interval: 1.04 to 1.95]; overweight, 1.56 [95% confidence interval: 1.21 to 1.88]; obese, 1.40 [95% confidence interval: 1.06 to 1.84]; severely obese, 1.92 [95% confidence interval: 1.35 to 2.75]; p < 0.05 for all).
Conclusions:
Among patients undergoing PCI, the prevalence of hsCRP elevation progressively increased with higher BMI. Measurement of hsCRP facilitates prognostic risk assessment for adverse outcome after PCI across a broad range of BMI.
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