High-sensitivity C-reactive protein predicts 10-year cardiovascular outcome after percutaneous coronary intervention

Oemrawsingh, Rohit M.; Cheng, Jin M.; Akkerhuis, K. Martijn; Kardys, Isabella; Değertekin, Muzaffer; Geuns, Robert‐Jan van; Daemen, Joost; Boersma, Eric; Serruys, Patrick W.; Domburg, Ron T. van

doi:10.4244/eijy15m07_04

Cited by 26 publications

(18 citation statements)

References 27 publications

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“…Показана связь между вероятностью рестеноза и содержанием в крови пациентов различных воспалительных маркеров (вч-СРБ, моноцитарный хемотаксический белок-1, миелопероксидаза, кардиотропин-1, интерлейкин-6, показатели активности тромбоцитов) [28][29][30][31]. Согласно результатам исследований [32][33][34], повышенный уровень вч-СРБ в пред-, пери-и в постпроцедурном периодах является фактором риска рестеноза в стенте. Согласно данным мета-анализа 6 проспективных исследований, включивших 1156 пациентов с ИБС (всего имплантировано 885 стентов, рестеноз внутри стента зарегистрирован в 194 случаях), высокие уровни вч-СРБ ассоциировались с повышенным риском рестеноза в стенте в течение 6-12 мес и определяли худший прогноз пациентов данной категории после коронарного стентирования [35].…”

Section: Discussionunclassified

The Incidence and Possible Predictors of Coronary Restenosis

et al. 2020

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Objective. Assess time and possible predictors of restenosis after the implantation of first- and second-generation coronary stents and bare metal stents (BMSs) in patients with stable coronary artery disease after elective coronary stenting.Materials and Methods. From 2010 to 2014, 3,732 (2,897 males, 60 [53; 68] years old) patients with stable exertional angina of functional class I–III underwent coronary stenting. From 2014 to 2017, 1,487 (1,173 males and 314 females) patients returned. Repeat coronary angiography was performed in 699 patients.Results. A total of 644 first-generation stents, 5,321 second-generation stents, and 473 BMSs were implanted. During the control coronary angiography, contrasting was repeated for 193 first-generation stents, 899 second-generation stents, and 77 BMSs. Restenosis (stenosis of 50 % or more in the previously stented segment) was detected in 28 (14 % of angiographic control) first-generation drug-eluting stents, 94 (10 %) second-generation drug-eluting stents, and 21 (27 %) BMSs. Patients with BMS restenosis returned significantly earlier than patients with restenosis of the first- and second-generation drug-eluting stents (11 [6, 27] months vs. 32 [11; 48]) months and 24 [12; 42] months, respectively; p<0.05). The initial and repeat levels of high-sensitivity C-reactive protein (hs-CRP) were higher in patients with restenosis (2.2 [1.2, 5.0] mg / L vs. 2.1 [1.0, 4.6] mg / L, respectively; p> 0.05) than in patients without restenosis (2.0 [0.9, 4.2] mg / L vs. 1.9 [0.7, 3.5] mg / L respectively, p>0.05). Blood levels of hs-CRP ≥2 mg / L according to receiver operating characteristic curve (ROC) analysis at return visit were used as a predictor to identify restenosis of stents with a diameter <3 mm and a length >25 mm – area under the curve (AUC) 0.67 (95 % confidence interval (CI) 0.51–0.84), p <0.05, odds ratio 3.7 (95 % CI 1.1–12.1), p<0.05. Stent type had a significant effect on the time to restenosis in the survival analysis (p<0.0005).Conclusion. The time from coronary stenting to the return visit of patients presenting with restenosis after the implantation of first- and second-generation drug-eluting stents is consistent; median time of the return visit of patients with restenosis of the first-generation stents was 2–3 years after coronary stenting. Blood levels of hs-CRP ≥2 mg / L at the return visit is a predictor of restenosis of stents with a diameter <3 mm and a length >25 mm.

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Section: Discussionunclassified

The Incidence and Possible Predictors of Coronary Restenosis

et al. 2020

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“…There is compelling evidence for an association between the elevated hsCRP and the long-term (follow-up of 4.8 years) risk of acute CV events such as CV death, MI, or stroke in patients with stable CHD [28]. Preprocedural hsCRP predicts long-term (up to 10-year follow-up) CV outcomes such as mortality, MI, stroke, and stent thrombosis in patients with stable CHD undergoing PCI with coronary artery stenting [29,32].…”

Section: Crp For CV Risk Assessmentmentioning

confidence: 99%

“…Rapidly accumulating evidence demonstrated the important role of CRP concentration for clinical risk stratification in patients with ACS with regard to mortality, recurrent MI, in-stent restenosis, and composite clinical endpoints [20,21,29,31,32,[35][36][37][38][39][40][41][42][43][44]. A meta-analysis by He et al [36] indicated that higher early CRP concentration (within the first 72 h of ACS onset) increases long-term risk of recurrent CV events (including MI) or death, and may be a valuable prognostic predictor after ACS, including homogenous populations with MI.…”

Section: Crp For Prediction Of Adverse Outcomes In Acsmentioning

confidence: 99%

The usefulness of C-reactive protein for the prediction of post-infarct left ventricular systolic dysfunction and heart failure

Świątkiewicz¹,

Taub²

2018

Kardiol Pol

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Acute myocardial infarction (MI) provokes a systemic inflammatory response that may contribute to the development of left ventricular systolic dysfunction (LVSD) and heart failure (HF). Patients with post-infarct HF with concomitant LVSD have the most unfavourable long-term prognosis. Measurement of C-reactive protein (CRP) concentration reflecting an involvement of inflammatory pathways in post-infarct myocardial damage offers an attractive strategy to improve risk stratification and clinical decision-making for early management of high-risk patients. Despite growing evidence for the prognostic value of CRP both as a single factor and as a component of multi-marker approach in MI, CRP measurement is not yet incorporated into current guidelines. This may be due to conflicting results reported in existing studies related to various limitations in study designs, such as retrospective case control design, prior myocardial damage, CRP measurement with low-sensitivity assays, non-homogenous populations with acute coronary syndromes, different treatment strategies, small sample sizes, and the lack of left ventricular ejection fraction assessment and long-term clinical and echocardiographic monitoring. As a result, previous studies have not provided conclusive evidence of the prognostic value of CRP for post-infarct LVSD or HF. Future studies with an adequate design including upstream mediators of inflammation as inflammatory markers are needed to identify the best biomarker-based strategies for identifying high-risk patients. Further clinical trials involving anti-inflammatory therapies target-ing different pathways of inflammatory activation in MI should test the inflammatory hypothesis of post-infarct LVSD and HF. Identifying high-risk patients with persistent post-infarct inflammatory response may allow incorporation of pathophysiological guidance for implementation of personalised treatment approaches.

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“…High-sensitivity C-reactive protein (hsCRP), a sensitive serum marker of acute and chronic systemic inflammation [1,2], is closely associated with outcomes of patients with various types of coronary heart diseases (CHD), including stable CHD and myocardial infarction (MI), and those undergoing percutaneous coronary intervention (PCI) [3][4][5][6]. Therefore, inflammation was generally considered detrimental in the context of atherosclerosis.…”

Section: Introductionmentioning

confidence: 99%

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

Chen

Liu

Zhou

et al. 2020

Mediators of Inflammation

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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.

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High-sensitivity C-reactive protein predicts 10-year cardiovascular outcome after percutaneous coronary intervention

Abstract: In patients undergoing PCI, higher CRP levels at the time of the procedure are predictive for 10-year mortality and myocardial infarction. High-sensitivity CRP may be a useful biomarker to improve further risk assessment in patients undergoing PCI.

Cited by 26 publications

References 27 publications

The Incidence and Possible Predictors of Coronary Restenosis

The Incidence and Possible Predictors of Coronary Restenosis

The usefulness of C-reactive protein for the prediction of post-infarct left ventricular systolic dysfunction and heart failure

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

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