C-reactive Protein For Risk Stratification Research Articles

Optical coherence tomography and C-reactive protein in risk stratification of acute coronary syndromes

BackgroundPatients with acute coronary syndrome (ACS) associated to high C-reactive protein (CRP) levels exhibit a higher risk of future acute ischemic events. Yet, the positive predictive value of CRP is too low to guide a specific treatment. Our study aims to identify a high-risk patient subset who might mostly benefit from anti-inflammatory treatment on the basis of the combination of optical coherence tomography (OCT) assessment of the culprit vessel and CRP serum levels. MethodsPatients admitted for ACS and undergoing pre-interventional OCT assessment of the culprit vessel were selected from “Agostino Gemelli” Hospital OCT Registry. The primary end-point was recurrent ACS (re-ACS). CRP levels ≥2 mg/L were considered abnormal. ResultsThe overall study population consisted of 178 patients. Among these, 156 patients were included in the primary end-point analysis. The re-ACS rate was 23% at 3-year follow-up. High CRP (2.587, 95% CI:1.345–10.325, p = 0.031), plaque rupture (3.985, 95% CI:1.698–8.754, p = 0.009), macrophage infiltration (3.145, 95% CI:1.458–9.587, p = 0.012) and multifocal atherosclerosis (2.734, 95% CI:1.748–11.875, p = 0.042) were independent predictors of re-ACS. All patients (14/14) with high CRP and with all OCT high-risk features had re-ACS. At the other extreme, only 4 of the 82 patients with low CRP levels and lack of high-risk features at OCT examination exhibited re-ACS at follow-up. ConclusionsThe combination of systemic evidence of inflammation and OCT findings in the culprit plaque identifies very high-risk ACS. Future studies are warranted to confirm these findings and to test an anti-inflammatory treatment in this patient subset.

Troponin and C-reactive Protein in Risk Stratification after Myocardial Infarction

Summary The aim of this study was to investigate the prognostic significance of troponin I, C-reactive protein and risk factors for the occurrence of complications after myocardial infarction. Troponin I and C-reactive protein values were analyzed in 38% of patients with complications (postinfarction angina, ventricular fibrillation, heart failure and fatal outcome) and in 62% of patients without complications. Values wererecorded on admission and between the eighth and tenth day of hospitalization. It was found that a larger number of risk factors (p = 0.00), diabetes mellitus (p = 0.02) and smoking (p = 0.01) were significantly associated with the complications. It was shown that hypertension increases the risk of developing heart failure after acute myocardial infarction (p = 0.02). It resulted with statistically non-significant difference in the observed values of troponin I between the group of patients with complications and the group without them (p = 0.22, p = 0.327). There was a statistically significant difference in the observed values of C-reactive protein in the two groups of patients (p = 0.00, p = 0.01). It can be concluded that the values of troponin I had no prognostic significance in risk stratification, while the values of C-reactive protein, individual risk factors and a large numberof risk factors hadsignificance in risk stratification after myocardial infarction.

CRP velocity and short-term mortality in ST segment elevation myocardial infarction

Context: There is a known association between C-reactive protein (CRP) levels and adverse outcomes in patients presenting with ST-elevation myocardial infarction (STEMI). The optimal time frame to measure CRP for risk stratification is not known.Objective: The aim of the current study was to evaluate the relation between the change in CRP velocity (CRPv) and 30-d mortality among STEMI patients.Material and methods: We included consecutive patients with a diagnosis of STEMI who presented to Tel-Aviv Medical Center between 2008 and 2014 and had their CRP measured with a wide range assay (wr-CRP) at least twice during the 24 h after admission. CRPv was defined as the change in wr-CRP concentration (mg/l) divided by the change in time (in hours) between the two measurements.Results: The study population comprised of 492 patients, mean age was 62 ± 14, 80% were male. CRPv was significantly higher among patients who died within 30 d of admission (1.42 mg/l versus 0.18 mg/l, p < 0.001). In a multivariate regression model adjusted to multiple confounders, CRPv was independently associated with 30-d mortality (OR 1.39, 95% CI: 1.20–1.62, p < 0.001).Conclusion: CRPv might be an independent and rapidly measurable biomarker for short-term mortality in patients presenting with STEMI.

Usefulness of combining serum uric acid and high-sensitivity C-reactive protein for risk stratification of patients with metabolic syndrome in community-dwelling women

Metabolic syndrome (MetS) is associated with an increased risk of major cardiovascular events. In women, increased uric acid (UA) levels are associated with MetS and its components. High-sensitivity C-reactive protein (hsCRP) levels are also associated with MetS, and hsCRP levels could be modulated by UA. We investigated whether combining UA and hsCRP levels are independently associated with MetS and insulin resistance in Japanese community-dwelling women. From a single community, we recruited 1,097 women (63 ± 12 years) during their annual health examination, and examined the cross-sectional relationship between UA, hsCRP, and MetS and insulin resistance, which was evaluated by homeostasis of minimal assessment of insulin resistance. Of these subjects, 218 women (19.9 %) had MetS. Multiple linear regression analysis was performed to evaluate the contribution of each confounding factor for MetS and insulin resistance, both UA and hsCRP as well as age and alcohol consumption, were independently and significantly associated with MetS and insulin resistance. The adjusted-odds ratios (95 % confidence interval) for MetS across tertiles of UA and hsCRP were 1.00, 1.45 (0.95–2.22), and 2.61 (1.74–3.93), and 1.00, 1.80 (1.18–2.74), and 3.23 (2.15–4.85), respectively. In addition, the combination increased UA, and hsCRP was also a significant and independent determinant for MetS and insulin resistance. In direction associations, we also observed a synergistic effect between these two molecules (F = 2.76, P = 0.027). These results suggested that combined assessment of UA and hsCRP levels provides incremental information for risk stratification of patients with MetS, independent of other confounding factors in community-dwelling women.

Usefulness of Combining Serum Uric Acid and C-Reactive Protein for Risk Stratification of Patients With Coronary Artery Disease (Bezafibrate Infarction Prevention [BIP] Study)

Combined assessment of serum uric acid (UA) and C-reactive protein (CRP) compared with single-marker evaluation in patients with coronary artery disease (CAD) was performed. CRP is an independent predictor of cardiac events in patients with or without CAD. Data regarding the prognostic value of UA in patients with CAD are conflicting. The primary end point (fatal or nonfatal myocardial infarction or sudden cardiac death) was related to levels of UA and CRP in 2,966 patients with CAD enrolled in the Bezafibrate Infarction Prevention trial who were followed for a mean period of 6.2 years. Primary end-point rates were directly related to increasing tertiles (from tertile 1 [T1] to tertile 3 [T3]) of UA (12.7%, 12.8%, and 17.6% respectively, p for trend <0.0001) and CRP (11.5%, 14.2%, and 17.3% respectively, p for trend <0.002). By multivariable analysis, T3 UA (>6.25 mg/dl) and T3 CRP (>5.37 mg/dl) were shown to be independently associated with a significant increase in risk for the primary end point (hazard ratio 1.30, 1.01 to 1.68, p = 0.04; hazard ratio 1.31, 1.02 to 1.69, p = 0.03, respectively). Primary end-point rates were similarly high in those patients with a combination of T3 UA and T1 CRP levels (hazard ratio 1.68, 1.05 to 2.66) or a combination of T3 CRP and T1 serum UA levels (hazard ratio 1.64, 1.04 to 2.58) or in patients with T3 of the 2 markers (hazard ratio 1.66, 1.07 to 2.59). In conclusion, combined assessment of UA and CRP levels provides incremental information for risk stratification of patients with CAD with low levels of a single marker.

Non-cardiovascular determinants of C-reactive protein levels in patients with cardiovascular diseases

C-reactive protein (CRP) plasmatic levels might increase in patients with acute coronary syndrome (ACS) or atherosclerosis and evaluation of CRP is relevant for prognosis in case of ischemic heart disease. This clear role played by CRP in risk stratification of cardiovascular diseases is however biased by non-cardiac determinants: genetic heritable factors, seasonal or daily variability, and gender differences probably based on hormonal differences. Also non-steroidal hormones seem to be involved in CRP determinism, in a complicated interaction not easy to extricate. Nevertheless, CRP determination in patients with ACS should be considered as crucial for its prognostic relevance, even after a careful consideration of all these bias factors.

Troponin and C-reactive Protein for Risk Stratification

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Analysis of N-terminal-pro-brain Natriuretic Peptide and C-reactive Protein for Risk Stratification in Stable and Unstable Coronary Artery Disease: Results From the AtheroGene Study

Analysis of N-terminal-pro-brain Natriuretic Peptide and C-reactive Protein for Risk Stratification in Stable and Unstable Coronary Artery Disease: Results From the AtheroGene Study

High-sensitivity C-reactive protein: potential adjunct for risk stratification in patients with stable congestive heart failure

To determine the potential adjunct of high-sensitivity (hs) C-reactive protein for risk stratification in patients with stable congestive heart failure (CHF). We studied 546 consecutive patients clinically stable with an ejection fraction <45% who were referred to our centre for evaluation of left ventricular dysfunction. hs C-reactive protein levels were determined on blood samples obtained on entry into the study. Clinical follow-up (median 972 days) was obtained for 545 patients. Cardiovascular mortality was significantly increased (P=0.001) in patients with hs C-reactive protein >3 mg/L. By multivariable analysis, including clinical, biological, and echocardiographic variables, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality [HR=1.78 (1.17-2.72); P=0.008]; the strongest predictive parameter in this model was B-type natriuretic peptide (BNP) (P=0.005). When peak VO(2) was included into the model, hs C-reactive protein >3 mg/L remained an independent predictor of cardiovascular mortality [HR=1.55 (1.02-2.38); P=0.04]; the strongest predictive parameter in this model was peak VO(2) (P<0.0001). In patients with ischaemic CHF, cardiovascular mortality was significantly increased in patients with hs C-reactive protein >3 mg/L (P=0.001), whereas in patients with non-ischaemic CHF, hs C-reactive protein >3 mg/L was not associated with cardiovascular mortality (P=0.098). By multivariable analysis, hs C-reactive protein >3 mg/L was an independent predictor of cardiovascular mortality in ischaemic patients [HR=2.16 (1.23-3.78)] but not in non-ischaemic patients [HR=1.05 (0.52-2.11)]. Cardiovascular mortality is increased in CHF patients with hs C-reactive protein >3 mg/L. The impact of hs C-reactive protein is independent of usual prognostic parameters, in particular BNP and peak VO(2). The interest of hs C-reactive protein determination appears to be especially marked in patients with ischaemic cardiomyopathy.

Analysis of N-Terminal-pro-Brain Natriuretic Peptide and C-Reactive Protein for Risk Stratification in Stable and Unstable Coronary Artery Disease: Results From the AtheroGene Study

Analysis of N-Terminal-pro-Brain Natriuretic Peptide and C-Reactive Protein for Risk Stratification in Stable and Unstable Coronary Artery Disease: Results From the AtheroGene Study

Broader indications for B-type natriuretic peptide testing in coronary artery disease

This editorial refers to ‘B-type natriuretic peptide: a novel early blood marker of acute myocardial infarction in patients with chest pain and no ST-segment elevation’† by R. Bassan et al. , on page 234 and ‘Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the Athero Gene study’‡ by R. Schnabel et al. , on page 241 B-type natriuretic peptide (BNP) is synthesized by cardiac myocytes when left ventricular wall stress increases. After secretion the pro-hormone is cleaved to the biologically active hormone (BNP) and an inactive N-terminal fragment (N-BNP). There is now reliable evidence that measuring the blood level of either BNP or N-BNP improves the ability to diagnose or exclude heart failure as the cause of acute dyspnoea,1 and provides powerful information on mortality risk both in patients with heart failure and in patients admitted to hospital with an acute coronary syndrome.2 Two papers in this issue of the European Heart Journal suggest that indications for BNP testing could be broadened further to include early diagnosis of myocardial infarction in patients with acute chest pain,3 and to risk assessment of patients with stable coronary artery disease.4 Bassan et al. 3 assessed the value of admission BNP for diagnosis of myocardial infarction in patients presenting with chest pain without ST-elevation on the electrocardiogram. The plasma level of BNP on admission was >100 pg/mL in ∼70% of patients subsequently diagnosed with myocardial infarction, while blood levels of creatinine kinase-MB (CK-MB) or troponin I were elevated in only ∼50% of these … *Tel: +64 9 630 9903; fax: +64 9 623 6422. E-mail address : rstewart{at}adhb.govt.nz

Analysis of N-terminal-pro-brain natriuretic peptide and C-reactive protein for risk stratification in stable and unstable coronary artery disease: results from the AtheroGene study

N-terminal-pro-brain natriuretic peptide (Nt-proBNP) is a reliable risk predictor in acute coronary artery disease (CAD). Little is known about patients with stable angina pectoris (SAP). We aimed to investigate the prognostic impact of Nt-proBNP in a population with CAD especially focussing on patients with SAP. We obtained baseline samples from a prospective cohort of 904 consecutive patients with CAD. Cardiovascular events were registered during follow-up (median 2 years; maximum 3.7 years). Baseline Nt-proBNP was significantly higher among individuals with cardiovascular events compared with those without (711.5 vs. 238.8 pg/mL; P<0.0001). A similar association was found if the analysis was performed in patients who presented with stable angina (330 vs. 166.5 pg/mL; P=0.006) or acute coronary syndrome (990.9 vs. 527.7 pg/mL; P=0.03). In the SAP group, patients within the top quartile (>487.9 pg/mL) had a 3.7-fold (95% CI 1.2-9.1; P=0.01) increase in cardiovascular risk. After adjustment for most potential confounders including left ventricular ejection fraction, Nt-proBNP remained predictive for patients with serum concentrations in the upper quartile in comparison with patients in the lowest quartile (hazard ratio highest vs. lowest quartile: 4.0; P=0.03) (n=417). Baseline concentration of Nt-proBNP is independently related to future cardiovascular events in patients with stable angina.

Should We Use CRP to Target Patients for Statin Therapy

Patients with elevated levels of the inflammatory marker C-reactive protein (CRP) are at higher risk for adverse coronary events than are patients whose CRP levels are not elevated. Recent data suggest that pravastatin reduces CRP levels independent of its effect on lipid levels. These researchers, one of whom holds a patent on the use of CRP in risk stratification, hypothesized that CRP levels could be effective …