Utility of High-Sensitivity C-Reactive Protein Versus Coronary Artery Calcium for the Detection of Obstructive Stenoses in Stable Patients

Abstract

The inflammatory biomarker high-sensitivity C-reactive protein (hs-CRP) has emerged as a predictor of future cardiovascular events. Screening for coronary artery calcium (CAC) is an alternative method for stratifying subjects by their cardiovascular risk. It is unclear, however, how hs-CRP compares with CAC scoring for the detection of obstructive coronary artery stenoses. We, thus, evaluated the association, if any, between hs-CRP and CAC scores for the detection of obstructive stenoses in a low-risk population with well-controlled traditional cardiovascular risk factors. In the present study of 1,079 stable subjects, 38 (3.5%) severely obstructive stenoses were found initially by coronary computed tomographic angiography and confirmed subsequently using invasive coronary angiography. The univariate predictors of severely obstructive coronary artery disease included the use of antihypertensive agents (p = 0.03), angina (p <0.001), and an elevated CAC score (p <0.001). The biomarker hs-CRP was not significantly associated with the presence of a severely obstructive stenosis. As the CAC scores increased, the frequency of obstructive stenosis also increased (p for trend <0.001). In contrast, the frequency of obstructive stenoses was low when CAC was not detected. This relation remained significant after adjustment for antihypertensive medication use and angina. In conclusion, hs-CRP was not useful for the prediction of obstructive stenoses in stable subjects. CAC was found to be a better predictor of obstructive heart disease than hs-CRP.