High-sensitivity C-Reactive protein predicts post-percutaneous coronary intervention cardiovascular risk with bmi threshold effect: evidence from a prospective registry study

Abstract Background High-sensitivity C-reactive protein (hsCRP) is a key prognostic factor in patients undergoing percutaneous coronary intervention (PCI). However, the impact of body mass index (BMI) on its prognostic value is debated. Purpose This study examines the association between elevated hsCRP and clinical outcomes in PCI patients according to BMI. Patients and Methods 19,027 patients who underwent PCI at a large tertiary care center were included and categorized into three BMI groups: normal (8.5 to 24 kg/m2, n=5,017), overweight (24 to 28 kg/m2, n =9,515), obese (≥ 28 kg/m2, n =4,495). Elevated hsCRP was defined as ≥2 mg/L. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCEs), including all-cause mortality, myocardial infarction, stroke, and revascularization. Results Elevated hsCRP was found in 26.7%, 31.1%, and 39.7% of the normal, overweight, and obese groups, respectively (p 0.001). MACCEs rates were higher in patients with elevated hsCRP in both overweight (9.1% vs. 11.1%) and obese (9.7% vs. 11.5%) groups. After multivariate adjustment, elevated hsCRP was significantly associated with MACCEs in overweight adj.HR = 1.19, 95% CI (1.04-1.36), p = 0.014 and obese adj.HR = 1.19, 95% CI (1.01-1.43), p = 0.043, but not in the normal group adj.HR = 1.04, 95% CI (0.85-1.27) , p = 0.690. Conclusion Elevated hsCRP is more prevalent in higher BMI groups and predicts worse outcomes in overweight and obese PCI patients.