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High-sensitivity C-reactive protein, plaque vulnerability and adverse events in patients with stable coronary
Masahiro Katamine1, Yoshiyasu Minami1, Takako Nagata1
1Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Insights
Higher high-sensitivity C-reactive protein (hsCRP) levels indicate more vulnerable coronary plaques in patients with coronary artery disease (CAD). This increases the risk of myocardial infarction, especially when thin-cap fibroatheroma (TCFA) is present.
Area of Science:
- Cardiology
- Biomarkers
- Vascular Biology
Background:
- Elevated high-sensitivity C-reactive protein (hsCRP) is linked to cardiovascular events in coronary artery disease (CAD) patients.
- Understanding plaque characteristics associated with hsCRP is crucial for risk stratification.
Purpose of the Study:
- To investigate the relationship between hsCRP levels and coronary plaque morphology.
- To assess the impact of hsCRP on clinical outcomes in stable CAD patients.
Main Methods:
- Optical coherence tomography (OCT) was used to analyze culprit lesions in 793 stable CAD patients.
- Patients were stratified into higher (hsCRP ≥0.2 mg/dL) and lower (hsCRP <0.2 mg/dL) hsCRP groups.
- Coronary plaque characteristics and clinical outcomes were compared between groups.
Main Results:
- Higher hsCRP levels correlated with a greater prevalence of thin-cap fibroatheroma (TCFA), a vulnerable plaque feature.
- Patients with higher hsCRP had a significantly higher incidence of myocardial infarction.
- The combination of high hsCRP and TCFA showed the highest risk of myocardial infarction.
Conclusions:
- Higher hsCRP levels are associated with vulnerable coronary plaque characteristics and adverse clinical outcomes in CAD.
- The presence of TCFA exacerbates the risk of recurrent myocardial infarction in patients with elevated hsCRP.
Background:
Higher levels of high-sensitivity C-reactive protein (hsCRP) are associated with increased risk of cardiovascular events in patients with coronary artery disease (CAD).
Aims:
To elucidate the characteristics of coronary plaques in patients with CAD with high hsCRP levels.
Methods:
A total of 793 consecutive patients with stable CAD who underwent optical coherence tomography (OCT) of the culprit vessel during percutaneous coronary intervention were included. Patients were classified into the higher hsCRP group (hsCRP ≥0.2 mg/dL, n = 247) or lower hsCRP group (hsCRP <0.2 mg/dL, n = 546). OCT characteristics and clinical outcomes were investigated according to hsCRP levels.
Results:
The prevalence of thin-cap fibroatheroma (TCFA) (32.0 % vs. 20.9 %, p < 0.001) was significantly higher in the higher hsCRP group than in the lower hsCRP group. The incidence of myocardial infarction was significantly higher in the higher hsCRP group than in the lower hsCRP group (log-rank p = 0.006) during a median follow-up of 938 days, although the incidence of major adverse cardiac events was comparable (log-rank p = 0.282). Among the four groups classified by hsCRP level and the presence of TCFA, the incidence of myocardial infarction was highest in the group with both higher hsCRP levels and TCFA (log-rank p = 0.017).
Conclusions:
Higher hsCRP levels were associated with a higher prevalence of vulnerable characteristics of coronary plaques and worse clinical outcomes in patients with stable CAD. The risk of recurrent myocardial infarction in patients with high hsCRP levels was further increased in the presence of TCFA.
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