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Clinical impact of systemic inflammation across different high-sensitivity C-reactive protein cutoffs in patients
Angelo Oliva1, Mark Shneyderman2, Mauro Gitto1
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.
Insights
High-sensitivity C-reactive protein (hsCRP) elevation above 2 or 3 mg/L indicates increased cardiovascular risk in patients undergoing percutaneous coronary intervention (PCI). Neither hsCRP threshold proved superior for risk prediction.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Systemic inflammation, indicated by high-sensitivity C-reactive protein (hsCRP), accelerates coronary atherosclerosis.
- Optimal hsCRP thresholds for predicting cardiovascular risk in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) remain debated.
Purpose of the Study:
- To evaluate the impact of different hsCRP thresholds on cardiovascular risk in patients undergoing PCI.
- To compare the predictive ability of hsCRP cutoffs at 2 mg/L and 3 mg/L for major adverse cardiovascular and cerebrovascular events (MACCE).
Main Methods:
- Retrospective analysis of 10,811 patients undergoing PCI between 2012 and 2022.
- Stratification of patients based on baseline hsCRP levels (<2 mg/L, 2-3 mg/L, >3 mg/L).
- Primary endpoint: MACCE (all-cause mortality, myocardial infarction, stroke).
Main Results:
- Elevated hsCRP (>2 mg/L or >3 mg/L) was associated with significantly increased MACCE rates.
- Patients with hsCRP between 2-3 mg/L showed higher MACCE risk (HR: 1.44) compared to those with hsCRP <2 mg/L.
- Both hsCRP thresholds demonstrated similar predictive ability for MACCE via ROC curve analysis.
Conclusions:
- hsCRP levels above both 2 mg/L and 3 mg/L predict increased 1-year MACCE risk in PCI patients.
- Neither 2 mg/L nor 3 mg/L emerged as a superior threshold for cardiovascular risk prediction.
- An hsCRP level between 2-3 mg/L signifies an elevated risk of adverse events post-PCI.
Background And Aims:
Systemic inflammation enhances coronary atherosclerosis progression and is assessed by high-sensitivity C-reactive protein (hsCRP). However, heterogeneity exists in defining the optimal hsCRP threshold associated with increased cardiovascular risk. Here we evaluated the impact of inflammation in patients with CAD undergoing percutaneous coronary intervention (PCI) using different cutoffs of hsCRP elevation.
Methods:
We conducted a retrospective analysis of patients undergoing PCI from 2012 to 2022 at Mount Sinai Hospital (NY, USA). Patients were stratified according to commonly used thresholds of baseline hsCRP. The primary endpoint was MACCE, defined as the composite of all-cause mortality, myocardial infarction, or stroke.
Results:
Of 10,811 patients included, 6210 (57.4 %) had hsCRP <2 mg/L, 1624 (15.0 %) between 2 and 3 mg/L, and 2977 (27.6 %) > 3 mg/L. Increased rates of MACCE were observed in each group with elevated hsCRP using both the hsCRP = 3 mg/L (4.9 % vs. 2.6 %; p < 0.001) and hsCRP = 2 mg/L thresholds (4.4 % vs. 2.4 %; p < 0.001). The risk of MACCE was also higher in patients with hsCRP values between 2 and 3 mg/L (HR: 1.44, 95 % CI 1.03-2.00; p = 0.032). For both thresholds, the receiver operating characteristic (ROC) curve showed similar ability to predict MACCE.
Conclusions:
In patients undergoing PCI, hsCRP values above both established thresholds of 2 and 3 mg/L predict an increased risk of 1-year MACCE, but neither threshold was superior in predicting cardiovascular risk. Patients with hsCRP between 2 and 3 mg/L have increased event rates compared to patients with hsCRP below 2 mg/L.
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