Both Low and High Postprocedural hsCRP Associate with Increased Risk of Death in Acute Coronary Syndrome Patients Treated by Percutaneous Coronary Intervention

Abstract

Background. Inflammation poses dual effects after myocardial infarction, but robust evidence shows that high-sensitivity C-reactive protein (hsCRP), as an inflammatory marker, is constantly associated with worse outcomes. This study is aimed at investigating the probable nonlinear association between postprocedural hsCRP and mortality in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention (PCI). Methods. A total of 3940 consecutive ACS patients treated by PCI with postprocedural hsCRP measurements were retrospectively recruited. Patients were stratified into 5 groups according to quintiles of hsCRP. Cox regression with adjustments for multiple covariates was used for outcome analysis. Restricted cubic spline (RCS) analysis was used to allow possible nonlinear associations. The primary outcome was all-cause death. Results. During a median follow-up of 727 days, mortality occurred in 207 (5.3%) patients. Adjusted hazard ratio (HR) was higher in the lowest (<2.26 mg/L, HR: 1.90, 95% confidence interval (CI): 1.08-3.33; P=0.025), second highest (10.16-12.56 mg/L, HR: 1.86, 95% CI: 1.09-3.16; P=0.023), and highest quintiles (≥12.56 mg/L, HR: 2.02, 95% CI: 1.21-3.36; P=0.007) of postprocedural hsCRP, compared to the second lowest quintile (2.26-4.85 mg/L). RCS analysis depicted a J-shaped association between postprocedural hsCRP and mortality (P for nonlinearity=0.004). Similar association was observed between hsCRP and cardiac death (P for nonlinearity=0.014), but not for noncardiac mortality (P for nonlinearity=0.228). Conclusions. Both low and high postprocedural hsCRP were associated with higher risk of death in ACS patients treated by PCI.

Estimation of Major Adverse Cardiovascular Events in Patients With Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Risk Prediction Score Model From a Derivation and Validation Study

“…Robust evidence (22)(23)(24) has shown that levels of inflammation markers, including hs-CRP and Ddimer, are constantly associated with worse mortality among patients with ACS who underwent PCI. Our previous study (25) revealed that during a median follow-up of 727 days, both low and high post-procedural hs-CRP levels were associated with a higher risk of death in patients with ACS who underwent PCI. Hs-CRP is the key marker of the interleukin (IL)-1β/IL-6/CRP pathway to synthesize and recruit leukocyte after myocardial damage (26).…”

Association between trimethylamine N‐oxide and prognosis of patients with acute myocardial infarction and heart failure

“…In this study, we found that hsCRP levels were not associated with MACE risk ( P = 0.077), which may be because we selected the median level of hsCRP as the cutoff while the cutoff was 2 or 3 mg/L to assess residual cardiovascular risk in most previous studies 11,34 . Besides, our previous study found that both low and high hsCRP levels were associated with increased risk of death in AMI patients, 12 which may partially explain that no significance in the median levels of hsCRP and MACE risk in this study. In addition, we observed that TMAO levels were negatively correlated with hsCRP levels ( P = 0.009), which is consistent with the result of the previous study 35,36 .…”

“…High‐sensitivity C‐reactive protein (hsCRP), a systemic inflammatory response marker, is extensively used to evaluate inflammatory risk in patients with myocardial infarction (MI) 10–12 . Some studies have suggested that TMAO may activate the inflammation cascade 13,14 .…”

“…High-sensitivity C-reactive protein (hsCRP), a systemic inflammatory response marker, is extensively used to evaluate inflammatory risk in patients with myocardial infarction (MI). [10][11][12] Some studies have suggested that TMAO may activate the inflammation cascade. 13,14 However, it remains unclear whether TMAO is related to a poorer prognosis in the population with acute myocardial infarction (AMI) and HF and whether it is associated with increased cardiovascular risk determined by hsCRP.…”

Preprocedural SII Combined with High-Sensitivity C-Reactive Protein Predicts the Risk of Contrast-Induced Acute Kidney Injury in STEMI Patients Undergoing Percutaneous Coronary Intervention

“…High-sensitivity C-reactive protein (hsCRP), as a marker of systemic inflammation, has been proven to be associated with increased relative risks of cardiovascular events in patients with coronary stenting. 27,28 In this study, compared with the non-CI-AKI group, the level of hsCRP in the CI-AKI group was significantly increased, and hsCRP was closely related to the incidence of CI-AKI. Liu et al demonstrated that the increase in hsCRP level is a significant and independent predictor of CI-AKI in STEMI patients treated with primary PCI, and those with higher hsCRP were associated with in-hospital mortality and composite MACEs closely related.…”