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Published on: January 28, 2020
The Role of the Association Between Serum C-Reactive Protein Levels and Coronary Plaque Macrophage Accumulation in
Simone Budassi1,2, Flavio Giuseppe Biccirè1,2,3, Giulia Paoletti2
1Cardiology Department, San Giovanni Addolorata Hospital, Rome, Italy.
Insights
High C-reactive protein (CRP) levels combined with plaque inflammation, specifically large and superficial macrophage accumulation detected by optical coherence tomography (OCT), predict cardiac events in patients.
Area of Science:
- Cardiology
- Inflammation Research
- Medical Imaging
Background:
- Systemic inflammation, indicated by C-reactive protein (CRP), plays a role in cardiovascular disease.
- Intra-plaque inflammation, particularly macrophage presence, is implicated in plaque vulnerability and cardiac events.
Purpose of the Study:
- To investigate the combined predictive value of systemic inflammation (CRP) and intra-plaque inflammation (macrophage burden via OCT) for cardiac events.
- To determine if high CRP levels modify the prognostic significance of plaque inflammation.
Main Methods:
- The CLIMA study included 689 patients with recorded admission CRP levels (high ≥ 2 mg/dl).
- Optical coherence tomography (OCT) was used to assess plaque inflammation, specifically macrophage arc.
- A composite endpoint of cardiac death, myocardial infarction, or target vessel revascularization at 1-year follow-up was analyzed.
Main Results:
- High CRP levels combined with a large and superficial macrophage arc on OCT were significant predictors of the composite endpoint (HR 2.27 and 2.78, respectively).
- Patients with high CRP and significant macrophage accumulation showed increased risk, while those with low CRP and similar plaque characteristics did not.
Conclusions:
- The interaction between high systemic inflammation (CRP) and specific intra-plaque inflammatory patterns (large/superficial macrophage arc) identifies patients at significantly higher risk for adverse cardiac events.
- OCT-detected macrophage burden, in the context of elevated CRP, provides crucial prognostic information for risk stratification.
Abstract:
The present investigation aims to study the interaction between systemic and intra-plaque inflammation in predicting cardiac events. We investigated C-reactive protein (CRP) levels as well as plaque inflammation with optical coherence tomography (OCT)-detected macrophages in the CLIMA study. 689 patients had admission CRP serum values reported, and high CRP values were defined as ≥ 2 mg/dl. The main study endpoint was a composite of cardiac death, myocardial infarction, and/or target vessel revascularization at 1-year follow-up. At multivariate Cox regression analysis, a large (hazard ratio [HR] 2.27, 95% confidence interval [CI] 1.2-4.3; p = 0.013) and superficial (HR 2.78, 95%CI 1.5-5.1; p = 0.001) macrophage arc was predicted of the main composite endpoint in patients with high CRP levels. Patients with large/superficial macrophage accumulation and low CRP levels were not at higher risk of adverse events. The presence of high CRP levels and large/superficial macrophage accumulation at OCT analysis identified patients at higher risk of clinical events.
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