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Association between high-sensitivity C-reactive protein and bleeding in dual antiplatelet therapy age: a
Wen-Fei He1,2, Li-Huan Zeng3, Zi-Jing Lin1
1Department of Cardiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
Insights
High-sensitivity C-reactive protein (hs-CRP) indicates a higher risk of bleeding in acute coronary syndrome (ACS) patients on dual antiplatelet therapy (DAPT). Elevated hs-CRP levels are linked to increased in-hospital major bleeding events.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Research
Background:
- Acute coronary syndrome (ACS) management often involves dual antiplatelet therapy (DAPT) after percutaneous coronary intervention.
- Bleeding is a significant complication in ACS patients receiving DAPT.
- Identifying predictors of bleeding risk is crucial for optimizing patient care.
Purpose of the Study:
- To investigate the association between high-sensitivity C-reactive protein (hs-CRP) and bleeding events in ACS patients treated with DAPT.
- To determine if hs-CRP is an independent predictor of major bleeding in this population.
Main Methods:
- An observational, multicentre study included 2583 adult patients with non-ST-segment elevation ACS (NSTE-ACS).
- Patients received DAPT after percutaneous coronary intervention.
- Major bleeding (Bleeding Academic Research Consortium grades 3-5) was the primary outcome, with death and any bleeding as secondary outcomes.
Main Results:
- 53 (2.1%) patients experienced major bleeding.
- Higher hs-CRP levels (>8.20 mg/L) were associated with a significantly higher incidence of in-hospital major bleeding (3.9%, p<0.001).
- Multivariable analysis confirmed hs-CRP as an independent predictor of in-hospital major bleeding (adjusted OR=1.01 per mg/L increase, p<0.001).
- An S-shaped association was observed between hs-CRP levels and major bleeding risk.
Conclusions:
- Systemic inflammation, indicated by hs-CRP, is associated with an increased risk of in-hospital major bleeding in NSTE-ACS patients on DAPT.
- The relationship between hs-CRP and bleeding events follows an S-shaped curve.
- Further research is needed to optimize antithrombotic therapy for high-bleeding-risk patients.
Objectives:
The aim of the present study was to investigate the association of high-sensitivity C-reactive protein (hs-CRP) with bleeding events among patients with acute coronary syndrome (ACS) received dual antiplatelet therapy (DAPT) after percutaneous coronary intervention.
Design:
An observational and multicentre study was conducted among non-ST-segment elevation ACS (NSTE-ACS).
Setting:
The study was conducted at five medical centres in China.
Participants:
This study retrospectively included 2583 adults with NSTE-ACS between 1 January 2010 and 31 December 2014.
Primary And Secondary Outcome Measures:
The primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3-5). The second outcome was death and any bleeding.
Results:
53 (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), p<0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR=1.01, 95% CI: 1.01 to 1.02, p<0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) =3.71, 95% CI: 1.35~10.23, p=0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels.
Conclusions:
Systemic inflammation marker hs-CRP in patients with NSTE-ACS who received DAPT is associated with a high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimise antithrombotic drug therapy in high bleeding risk patients during follow-up.
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