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Preprocedural hs-CRP level predicts long-term outcomes after first radiofrequency ablation in patients with
Yuxin Bi1, Xiaodong Peng1, Fengyuan Lu1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen Hospital, Beijing, China.
Insights
Pre-ablation high-sensitivity C-reactive protein (hs-CRP) levels predict long-term cardiovascular death and stroke risk in atrial fibrillation (AF) patients. This inflammation marker aids risk assessment beyond rhythm control after AF ablation.
Area of Science:
- Cardiology
- Biomarkers
- Atrial Fibrillation Management
Background:
- Catheter ablation is used to restore sinus rhythm in atrial fibrillation (AF).
- Long-term cardiovascular risk post-ablation is not fully understood.
- The prognostic role of pre-ablation high-sensitivity C-reactive protein (hs-CRP) is unclear.
Purpose of the Study:
- To determine if pre-ablation hs-CRP levels are associated with long-term cardiovascular outcomes after AF ablation.
- To investigate hs-CRP as a predictor of adverse events post-procedure.
Main Methods:
- Analysis of 4,612 patients with nonvalvular AF undergoing first-time radiofrequency ablation.
- Prospective data from the China-AF Registry (2011-2023) with a median 5.0-year follow-up.
- Cox models used to assess the association between baseline hs-CRP (continuous and tertiles) and primary composite endpoint (cardiovascular death/ischemic stroke), adjusted for confounders.
Main Results:
- Higher baseline hs-CRP independently predicted an increased risk of the primary endpoint (aHR 1.21, P<0.001) with a dose-response effect.
- The association was stronger in younger patients (<65 years) and persisted even without AF recurrence (aHR 1.26, P=0.006).
- Elevated hs-CRP also correlated with higher cardiovascular readmission risk, but weaker associations were seen with bleeding and AF recurrence.
Conclusions:
- Pre-ablation hs-CRP is an independent predictor of long-term cardiovascular death and ischemic stroke following AF ablation.
- hs-CRP provides valuable prognostic information, even in patients who achieve rhythm control.
- Inflammation assessment using hs-CRP can enhance risk stratification beyond rhythm outcomes in AF ablation patients.
Background:
Catheter ablation restores sinus rhythm in atrial fibrillation (AF), but long-term cardiovascular risk remains incompletely defined. The prognostic value of high-sensitivity C-reactive protein (hs-CRP) after ablation is uncertain.
Objective:
This study aimed to investigate the association between preprocedural hs-CRP levels and long-term cardiovascular outcomes after AF ablation.
Methods:
We analyzed 4612 patients with nonvalvular AF undergoing first-time radiofrequency ablation in the prospective Chinese Atrial Fibrillation Registry (2011-2023), with a median follow-up of 5.0 years. Baseline hs-CRP was measured using a high-sensitivity immunoturbidimetric assay and analyzed as log-transformed continuous values and tertiles. The primary endpoint was a composite of cardiovascular death and ischemic stroke. Secondary endpoints included life-threatening bleeding, AF recurrence, and cardiovascular readmission. Cox models adjusted for demographic factors, comorbidities, AF type, and medications.
Results:
Higher baseline hs-CRP was independently associated with an increased risk of the primary endpoint (adjusted hazard ratio, 1.21; 95% confidence interval, 1.10-1.33; P < .001) with a significant dose-response relationship across tertiles. The association was stronger in patients aged <65 years (interaction P = .006) and remained significant in patients without AF recurrence (hazard ratio, 1.26; P = .006). Elevated hs-CRP was also associated with a higher risk of cardiovascular readmission. Associations with life-threatening bleeding and AF recurrence were weaker.
Conclusion:
Preprocedural hs-CRP independently predicts long-term cardiovascular death and ischemic stroke after AF ablation, even in patients without recurrence. These findings support inflammation-based risk stratification beyond rhythm outcomes.
