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Relationship of Serial High-Sensitivity C-Reactive Protein Changes to Long-term Clinical Outcomes in Stabilised
Myunhee Lee1, Kyusup Lee1, Dae-Won Kim1
1Division of Cardiology, Daejeon St Mary's Hospital, College of Medicine, Catholic University of Korea, Daejeon, Republic of Korea.
Insights
Persistently high high-sensitivity C-reactive protein (hsCRP) levels one year after myocardial infarction (MI) and percutaneous coronary intervention (PCI) predict poor long-term outcomes. Serial hsCRP measurements aid in identifying high-risk post-MI patients.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Limited understanding of serial high-sensitivity C-reactive protein (hsCRP) and long-term outcomes post-myocardial infarction (MI).
- Need for effective risk stratification in stabilized post-MI patients after percutaneous coronary intervention (PCI).
Purpose of the Study:
- Investigate the utility of serial hsCRP measurements for risk stratification.
- Assess the association between hsCRP levels and long-term adverse events in post-MI patients.
Main Methods:
- Included 1018 patients with baseline and 1-year hsCRP measurements post-MI.
- Defined high inflammatory status as hsCRP > 2 mg/L.
- Categorized patients into 4 groups based on hsCRP trends: persistently low, falling, rising, and persistently high.
- Primary outcome: major adverse cardiac and cerebrovascular events (MACCE) within 4 years.
Main Results:
- Persistently high hsCRP was observed in 19.4% of patients at 1 year.
- MACCE incidence increased progressively across groups: 4.8% (persistently low) to 13.2% (persistently high).
- Persistently high hsCRP independently predicted MACCE (aHR 2.55) and improved risk prediction models.
Conclusions:
- Persistently high hsCRP 1 year post-MI and PCI is linked to adverse long-term clinical outcomes.
- Serial hsCRP measurements can identify high-risk patients for mortality and morbidity.
- This approach enhances risk stratification in the post-MI population.
Background:
Little is known about the association between serial high-sensitivity C-reactive protein (hsCRP) measurements and long-term outcomes in post-myocardial infarction (MI) patients. We aimed to investigate the usefulness of serial hsCRP measurements for risk stratification in stabilised post-MI patients after percutaneous coronary intervention (PCI).
Methods:
A total of 1018 patients who had hsCRP values at both baseline and 1 year after MI were included. High inflammatory status was defined as hsCRP > 2 mg/L. Patients were classified into 4 groups: persistently low, falling (first high then low hsCRP), rising (first low then high hsCRP), and persistently high hsCRP. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause of death, MI, and cerebrovascular accident) within 4 years after the second hsCRP measurement.
Results:
At 1 year after MI, the numbers of patients in the persistently low, falling, rising, and persistently high hsCRP groups were 394 (38.7%), 358 (35.2%), 69 (6.8%), and 197 (19.4%), respectively. The incidence of MACCE was progressively elevated from the persistently low to the falling, rising, and persistently high hsCRP groups (4.8%, 8.1%, 10.1%, and 13.2%, respectively; P = 0.004). Persistently high hsCRP was an independent predictor of MACCE (adjusted hazard ratio 2.55; 95% confidence interval 1.35-4.81; P = 0.004) and provided incremental prognostic value beyond that of the baseline clinical risk model (net reclassification improvement = 0.397; integrated discrimination improvement = 0.025; all P < 0.001).
Conclusions:
Among stabilised post-MI patients who underwent PCI, persistently high hsCRP was frequently seen 1 year after MI and was strongly associated with long-term adverse clinical outcomes. Serial measurements of hsCRP during clinical follow-up after MI may help to identify patients at higher risk for mortality and morbidity.
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