High-Sensitivity C-Reactive Protein and Risk of Recurrent Vascular Events in Patients With Stroke Associated With...

Area of Science:

• Cardiology
• Neurology
• Vascular Medicine

Background:

• Complex aortic atheroma (CAA) is a significant risk factor for ischemic stroke.
• Predictors of recurrent vascular events in CAA-related stroke are not well-defined.
• Systemic inflammation may play a role in stroke recurrence.

Purpose of the Study:

• To evaluate the prognostic value of high-sensitivity C-reactive protein (hsCRP) in patients with CAA-related stroke.
• To determine if hsCRP levels can predict major adverse cardiovascular events (MACE).
• To assess the association between hsCRP and recurrent vascular events.

Main Methods:

• Prospective, observational registry of consecutive stroke patients within 1 week of onset.
• Transesophageal echocardiography (TEE) used for embolic-source evaluation and CAA definition (plaque ≥4 mm, ulceration, or mobile components).
• Patients dichotomized by hsCRP level (≥3.0 mg/L vs. <3.0 mg/L); primary outcome was 1-year MACE.

Main Results:

• Out of 1,214 patients, 335 underwent TEE, identifying CAA in 83 (24.8%).
• Among 76 patients with hsCRP data and 1-year follow-up, 17 experienced MACE (23.2% event rate).
• MACE incidence was significantly higher in patients with hsCRP ≥3.0 mg/L (42.2%) compared to hsCRP <3.0 mg/L (15.3%; P=0.010).
• Elevated hsCRP (≥3.0 mg/L) independently predicted MACE (HR 4.68; 95% CI 1.43-15.32).

Conclusions:

• Elevated hsCRP is an independent predictor of MACE in CAA-related stroke.
• hsCRP can aid in risk stratification for patients with CAA and stroke.
• These findings highlight the role of systemic inflammation in the vascular events of this high-risk subgroup.