Abstract 18709: Association of Reactive Oxygen Metabolites and High-sensitivity CRP with severity of angiographic Coronary Artery Disease

Abstract

Background: Reactive oxygen species (ROS) and inflammation play the role in the pathogenesis and the development of coronary artery disease (CAD), and high-sensitivity C-reactive protein (hs-CRP), a marker for low-grade inflammation, is one of the most studied biomarkers for the evaluation of CAD risk. In contrast, there is little biomarker of ROS, which is easy to assay and is widely accepted as marker of CAD. Hence, in this study, we compared associations of hs-CRP and derivatives of reactive oxygen metabolites (d-ROM), a newly and easier-to-assay marker of ROS, with the severity of CAD. Methods: We examined the presence of CAD by coronary angiography (coronary stenosis ≥ 50% luminal diameter narrowing) and CAD patients were divided to single-vessel disease (SVD) or multiple-vessel disease (MVD) according to the number of vessels. In consecutive CAD patients, we assessed d-ROM by simpler method for detecting hydroperoxide as a marker of ROS, and compared association between hs-CRP and severity of CAD. Results: In preliminary study, d-ROM values were significantly increased in CAD patients compared to control patients. In consecutive 261 CAD patients, d-ROM values were significantly higher in CAD patients with MVD (n=172) than CAD patients with SVD (n=89) (d-ROM: CAD+SVD; 332.2 ± 70.9 U.CARR versus CAD+MVD; 353.2 ± 70.5 U.CARR, p<0.05). In receiver-operating characteristic analysis, d-ROM values was a significant determinant for the severity of CAD (area under the curve; 0.60, 95% confidence interval; 0.52-0.67, p<0.01). In contrast, hs-CRP of CAD patients with MVD were not changed compared to those of CAD patients with SVD (ln[hs-CRP]: CAD+SVD; -2.79 ± 1.12 mg/dL versus CAD+MVD; -2.65 ± 1.09 mg/dL, p=0.32). By multivariate backward logistic regression analysis among various risk factors, d-ROM values, but not hs-CRP independently associated with the severity of CAD (p<0.05). Conclusion: d-ROM values reflecting ROS levels significantly increased in CAD patients and significantly correlated with the severity of CAD. d-ROM assay might be a more important biomarker than hs-CRP to evaluate the severity of CAD and screen for CAD in high-risk patients. Identifying the high-risk CAD patients by d-ROM may provide clinical benefits for risk stratification.