Predictive value of C-reactive protein in patients with unstable angina pectoris undergoing coronary artery stent implantation

This study was aimed at establishing the relation between baseline C-reactive protein levels and 12-month outcome in patients with unstable angina successfully treated with coronary artery stent implantation. Our results suggest that in patients with unstable angina and 1-vessel coronary disease successfully treated with coronary artery stent implantation, normal baseline serum levels of C-reactive protein identify a subgroup of patients at low risk of cardiac events during follow-up.     

Independent prognostic value of C-reactive protein and troponin I in patients with unstable angina or non-Q-wave myocardial infarction.

OBJECTIVES: Elevated concentrations of C-reactive protein (CRP), a non-specific acute phase reactant, and troponin I (TnI), a cardiac-specific marker of myocardial damage, have been found to be associated with a higher risk for cardiac events in patients with an acute coronary syndrome. We evaluated CRP alone and in combination with TnI for predicting the incidence of major cardiac complications within 6 months in patients with unstable angina or non-Q-wave infarction (NQMI). METHODS: CRP and TnI was measured on admission in patients with unstable angina or NQMI, but results were kept blinded. Patients were treated according to a conservative management strategy, and the incidence of major cardiac events within 6 months was assessed. RESULTS: An abnormal CRP (> 5 mg/l) and an abnormal TnI (> 0.4 microgram/l) were more frequent in patients that suffered a major cardiac event (CRP: 93 vs. 35%, P < 0.0001; TnI: 73 vs. 26%, P < 0.001). The incidence of major cardiac events was higher in patients with an abnormal CRP than in patients with a normal CRP, both when TnI was abnormal (42 vs. 4.5%, P = 0.003) and when TnI was normal (11 vs. 0%, P = 0.014). Mean event-free survival was excellent in patients with both a normal CRP and TnI, whereas survival was poorest in patients with both an abnormal CRP and TnI (121 +/- 16 vs. 180 days, P < 0.0001). CONCLUSIONS: An abnormal CRP on admission in patients with unstable angina or NQMI is associated with increased incidence of major cardiac events within 6 months, both in patients with normal and abnormal TnI. CRP and TnI have independent and additive prognostic value in this patient group, and the combination may be useful for early risk stratification.     

C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina

The aim of this study was to investigate the possible association of plasma C-reactive protein (CRP) levels with the presence of angiographically multiple complex lesions (CLs) in patients with primary unstable angina (PUA). For the purpose of this study, 228 consecutive patients with PUA who underwent in-hospital catheterization were evaluated. Plasma CRP levels were measured upon patients' admission. Coronary plaques were classified as CL or non-CL according to Ambrose's criteria. There were 100 (43.9%) patients with no or one CL (/=2). Tertiles of plasma CRP levels upon admission were significantly associated with the number of CLs on angiographic studies. In particular there was a significant gradual increase in either the number of CLs, or the presence of apparently thrombus-containing CLs with increasing of CRP tertiles. By multivariate analysis CRP was independently associated with the presence of either multiple CLs (R.R.=1.8, 95%CI=1.5-2.2, P<0.001), or angiographically apparent thrombus-containing CLs (R.R.=1.4, 95%CI=1.2-1.7, P=0.03).High plasma levels of CRP may reflect a multifocal activation of the coronary tree in patients with PUA. This finding suggests a generalized inflammatory reaction throughout the coronary tree in these patients.     

C反应蛋白水平对不稳定性心绞痛的预后价值

目的：评价C反应蛋白(CRP)对不稳定性心绞痛(UAP)患预后的价值。方法：测定105例UAP患的血清CRP含量，并观察其终点事件的发生。结果：CRP＞3．6mg/L的UAP患其急性心肌梗死、心脏事件发生率明显高于CRP＜3．6mg/L的UAP患(P＜0．01)。结论：血CRP水平升高是不稳定性心绞痛预后的预测因子。     

高敏C反应蛋白预测冠状动脉痉挛患者预后价值的研究

目的:评价高敏C反应蛋白(high-sensitivity C reaction protein,hs-CRP)预测冠状动脉痉挛预后的价值。方法:检测120例明确冠状动脉痉挛患者入院时血浆hs-CRP浓度,经治疗出院后进行电话/门诊随访6个月了解胸痛再发情况,对临床诸因素进行Logistic回归分析,研究冠状动脉痉挛再发的危险因素。建立ROC曲线,评价血浆hs-CRP判断冠状动脉痉挛预后的价值。结果:120例患者中再发胸痛36例,再发胸痛组hs-CRP浓度显著高于非胸痛再发组[中位数为5.4(4.6,7.5)mg/L比4.6(3.6,6.4)mg/L,P<0.05]。各临床因素进行Logistic回归分析,提示hs-CRP(OR=1.55,95%CI:1.02～1.35,P=0.03)和吸烟(OR=1.26,95%CI:1.12.～1.65,P=0.02)是冠状动脉痉挛复发的危险因素。入院hs-CRP在判断预后的ROC曲线下,面积为(0.83,95%CI:0.812～0.819,P<0.05),并将切点值定为1.6mg/L,此值预测胸痛再发敏感性和特异性分别为89%和81%。结论:hs-CRP增高和吸烟是冠状动脉痉挛胸痛再发的危险因素,以1.6mg/L为切点其预测预后的敏感性、特异性分别为89%和81%。     

Relation of C-reactive protein to coronary collaterals in patients with stable angina pectoris and coronary artery disease

The heterogeneity in the degree of collateralization among patients with coronary artery disease (CAD) is poorly understood. We sought to determine whether chronic subclinical inflammation is related to coronary collateral development in patients with chronic stable angina pectoris and obstructive CAD. High-sensitivity C-reactive protein (CRP) levels were measured in 177 patients with stable angina pectoris before coronary angiography. Multivariable logistic regression revealed an inverse graded association between CRP and the presence of coronary collaterals (Rentrop grade 1 to 3). Compared with patients in the first CRP tertile, the adjusted odds ratio for the presence of coronary collaterals was 0.70 (95% confidence interval, 0.33 to 1.52; p = 0.45) for patients in the second CRP tertile and 0.33 (95% confidence interval, 0.15 to 0.75; p = 0.008) for patients in the third CRP tertile (p for trend = 0.008). In conclusion, an inverse graded association exists between CRP and the presence of coronary collaterals in patients with stable angina pectoris.     

Clinical risk stratification correlates with the angiographic extent of coronary artery disease in unstable angina

OBJECTIVES

We sought to determine whether clinical risk stratification correlates with the angiographic extent of coronary artery disease (CAD) in patient with unstable angina.

BACKGROUND

The Agency for Health Care Policy and Research (AHCPR) guidelines stratify patients with unstable angina according to short-term risk of myocardial infarction or death. Whether these guidelines are useful in predicting the extent of CAD is unknown.

METHODS

All residents of Olmsted County, Minnesota, undergoing emergency department evaluation from January 1, 1985 through December 31, 1992 for unstable angina without a history of prior coronary artery bypass grafting, and who underwent early angiography (within seven days of presentation) were classified into low, intermediate and high risk subgroups based on AHCPR criteria.

RESULTS

Seven hundred ninety-five patients underwent early angiography: 159 high risk, 572 intermediate risk and 64 low risk patients. Logistic regression analysis demonstrated that low risk patients had a greater likelihood of normal or mild CAD relative to intermediate risk (odds ratio [OR], 4.67; 95% confidence interval [CI], 2.70–8.06; p < 0.001) and high risk (OR, 11.1; 95% CI, 5.71–22.2; p < 0.001). Significant 1-, 2-, 3-vessel coronary disease or left main coronary disease was more likely in high relative to low risk (OR, 8.09; 95% CI, 4.22–15.5; p < 0.001), intermediate relative to low risk (OR, 4.11; 95% CI, 2.34–7.22; p < 0.001), and high relative to intermediate risk (OR, 1.97; 95% CI, 1.31–2.96; P = 0.0012).

CONCLUSIONS

Among patients with unstable angina undergoing early coronary angiography, risk stratification according to the AHCPR guidelines correlates with the angiographic extent of CAD.     

Interleukin-18: a strong predictor of the extent of coronary artery disease in patients with unstable angina

The aim of this study was to confirm that plasma interleukin (IL)-18 level is associated with the extent of coronary artery disease in unstable angina patients. Previous studies have shown that patients with unstable angina have significantly higher plasma IL-18 levels than healthy volunteers. However, the association between IL-18 and the extent of coronary artery atherosclerosis in patients with unstable angina remains unclear. Plasma concentrations of IL-18 and high-sensitivity C-reactive protein (hs-CRP) were measured in 166 consecutive patients admitted for coronary arteriography. One hundred and eighteen patients with unstable angina had coronary artery disease (coronary artery disease group; severity score: 2.32 ± 1.47; Gensini score: 31.3 ± 25.9), and 48 patients with coronary risk factors and without coronary artery lesions served as the risk control group. Plasma levels of IL-18 were higher in the coronary artery disease group than in the risk control group (P = 0.062). Additionally, plasma levels of IL-18 were significantly higher in 77 coronary artery disease patients with severity score ≥2 than in the risk control group (242.3 ± 110.6 vs 209.8 ± 120.3 pg/ml, P = 0.016). By univariate analysis, log-transformed plasma IL-18 concentration was positively correlated with coronary artery disease severity score (r = 0.244, P = 0.009). By multiple regression analyses, the association between coronary artery disease severity score and IL-18 remained significant (β = 0.733, P = 0.017) when controlling for age, diabetes mellitus and left ventricular ejection fraction. Additionally, coronary artery disease severity score was greater in the highest tertile (>246 pg/ml) of plasma IL-18 levels than in the middle (176–246 pg/ml) and the lowest (<176 pg/ml) tertiles (2.79 ± 1.52 vs 2.05 ± 1.08 vs 2.13 ± 1.66, P = 0.028). Of note, plasma hs-CRP level had no significant correlation with coronary artery severity. Plasma IL-18 level is associated with the extent of coronary artery disease in unstable angina patients, suggesting the link between IL-18 and coronary artery atherosclerosis in these patients.     

Instability of coronary lesions in unstable angina assessed by C-reactive protein values following coronary interventions

The instability of coronary lesions was evaluated in 30 patients with stable angina and 60 patients with unstable angina. The grade of instability of coronary lesions as predicted by the increases in C-reactive protein induced by PTCA and/or stenting was closely correlated with Braunwald's classification of unstable angina.     

C-reactive protein and coronary artery disease

Evidence suggests that inflammation plays a key role in the pathogenesis of atherosclerosis. The chronic inflammatory process can develop to an acute clinical event by the induction of plaque rupture and therefore cause acute coronary syndromes. The aim of this study was to determine the serum levels of the circulating acute-phase reactant C-reactive protein (CRP), which is a sensitive indicator of inflammation, in patients with chronic stable coronary artery disease (CAD) and acute coronary syndromes (ACS). We studied 56 subjects: 1) 25 consecutive patients (18 men, 7 women; mean age, 68.5 +/- 14.3 years, range, 40-86) with unstable angina (UA) or acute myocardial infarction (AMI); 2) 31 consecutive patients (25 men, 6 women; mean age 64 +/- 12.7; range, 47-83, years) with signs and symptoms of clinically stable CAD. High-sensitivity-C-reactive protein (hs-CRP) levels were determined with a commercially available enzyme-linked immunoassay method. In patients with unstable angina and AMI before reperfusion therapy, CRP levels were not significantly different to those in patients with stable CAD (5.96 +/- 2.26 versus 4.35 +/- 2.6 mg/L; P = 0.12), but tended to be higher in patients with unstable angina and AMI. Baseline CRP levels in the subgroup of patients with AMI (6.49 +/- 2.28 mg/L) were significantly higher than levels in patients with stable CAD (4.35 +/- 2.6 mg/L; P = 0.02). CRP levels in patients with unstable angina and AMI were measured four times during a 72-hour period (0, 12, 24, and 72 hours). The lowest value was observed at baseline and differed significantly from values measured at any other time of the observation period (P < 0.001; 5.96 +/- 2.26; 9.5 +/- 9.04, 18.25 +/- 11.02; 20.25 +/- 10.61). CRP levels after 12, 24, and 72 hours were also significantly different to the initial values for patients with stable CAD (P < 0.01). There was no correlation between CRP and creatine kinase (CK), CK-MB isoenzyme, or troponin I positivity as markers for the extent of the myocardial injury during the observation period. Baseline levels of serum CRP tended to be higher in patients with unstable angina or AMI but were not significantly different from levels in patients with chronic stable CAD. In the subgroup of patients with AMI, baseline CRP levels were significantly higher than the levels in patients with stable CAD. CRP as a marker of inflammation is significantly increased in patients with AMI and unstable angina shortly after the onset of symptoms (after a period of 12 hours), supporting the hypothesis of an activation of inflammatory mechanisms in patients with an acute coronary syndrome or AMI.     

Prognostic value of C-reactive protein and troponin T level in patients with unstable angina pectoris

OBJECTIVES: The prognosis of unstable angina pectoris may be more accurately predicted by the combination of C-reactive protein (CRP), which is a known inflammation marker, and troponin T (TnT), which is used for risk assessment for the prognosis of acute coronary syndrome. The present study investigated the correlations between pathophysiology and prognosis of severe unstable angina pectoris and CRP and TnT levels. METHODS: The correlation between CRP at admission and the prognosis was studied in 367 patients with severe unstable angina pectoris (Braunwald type II and III) who were admitted to our hospital between January 1998 and December 2000. The in-hospital and long-term prognosis was investigated in TnT-positive patients. In-hospital cardiac events were defined as death, myocardial infarction, heart failure and angina attacks during hospitalization. Long-term cardiac events were defined as death, myocardial infarction, heart failure and recurrence of angina. RESULTS: The incidence of in-hospital cardiac events in all patients was 30.2%. The CRP levels were higher in patients with cardiac events (0.97 +/- 2.67 vs 0.53 +/- 1.29 mg/d/, p = 0.057), but there was no significant difference between the two groups. The incidence of long-term cardiac events was 26.8%. The mean CRP level was significantly higher in patients with cardiac events than in patients without cardiac events (1.17 +/- 1.86 vs 0.43 +/- 1.14 mg/dl, p = 0.098). In TnT-positive patients (TnT > 0.1 ng/ml, 23% of all patients), the incidence of in-hospital cardiac events was 47.6% (p < 0.0001), significantly higher than that in all patients. TnT-positive patients with CRP levels of 0.5 mg/dl or higher (8% of all patients) had a markedly higher incidence of in-hospital cardiac events of 56.7% (p = 0.001) and long-term cardiac events of 46.7% (p = 0.01). CONCLUSIONS: CRP levels were useful in prediction of the long-term prognosis. TnT levels were useful in prediction of in-hospital prognosis. The present study suggested the possibility that the combined use of these biological markers could predict the prognosis of patients with unstable angina at early stage and more accurately.     

踝臂指数联合超敏C反应蛋白对冠状动脉病变的判定价值

目的:探讨踝臂指数(ABI)联合超敏C反应蛋白(hs-CRP)对冠状动脉病变的判定价值。方法:选择2010-09-12期间住院并行冠状动脉造影的120例患者,收集行冠状动脉造影前ABI及hs-CRP的数值,根据冠状动脉病变狭窄程度(Gensini积分评价)及病变血管数量进行分组。结果:以ABI<0.9及hs-CRP>3mg/L为截断值,二者联合检测判定冠状动脉严重狭窄及多支病变的敏感度分别为85%和92%,特异度分别为69%和61%,与单用ABI或hs-CRP的方法比较,其敏感度均显著提高(均P<0.05),特异度有所下降。结论:ABI、hs-CRP的水平变化与冠状动脉的病变程度密切相关,对于冠状动脉严重狭窄及3支病变的判定,二者联合检测具有更高的实用价值。     

C反应蛋白对不稳定型心绞痛危险分层的价值

目的：探讨C反应蛋白（CRP）对不稳定型心绞痛（UA）危险分层的临床价值。方法：对109例UA患者入院时分别测定CRP、心脏肌钙蛋白T（cTNT)、肌酸磷酸激酶同工酶（CK－MB），随访三个月，观察终点为急性心肌梗死（AMI）和心源性猝死。结果：在109例UA患者中，CRP升高37例（34.2%)，正常72例（66.1%)，三个月中发生急性心肌梗死10例，心源性猝死5例，冠状动脉成形术（PTCA）15例，冠脉搭桥术（CABG）6例。其中CRP升高组AMI的发生率明显高于正常组（P＜0.01)，但死亡率无明显差别。CRP的敏感度（83.33%)较TNT、CK－MB增高。多因素Logistic回归分析CRP升高、cTNT升高、陈旧性心梗和胸痛次数是预测近期AMI、心源性猝死的独立危险因素。结论：CRP对UA患者的近期预后和早期治疗有重要的临床价值，是危险分层的良好指标之一。