Key result
Increased pre-procedural C-reactive protein (>3 mg/L) in patients undergoing elective coronary angioplasty predicted a higher 2-year rate of death or MI compared to normal levels (10.6% vs 2.9%).
Why the study?
Does an increased pre-procedural C-reactive protein level predict death or myocardial infarction in patients with stable coronary artery disease undergoing elective coronary angioplasty?
Cohort (n=501)
Does an increased pre-procedural C-reactive protein level predict death or myocardial infarction in patients with stable coronary artery disease undergoing elective coronary angioplasty?
Effect estimate: RR 3.9 (95% CI 1.7-8.9)
Absolute Event Rate: 10.6% vs 2.9%
Elevated pre-procedural C-reactive protein (>3 mg/L) is a powerful independent predictor of death or myocardial infarction in patients undergoing elective coronary angioplasty.
May support CRP-based risk stratification before elective angioplasty; leaves open whether inflammation-targeted interventions improve outcomes.
AIMS: The acute phase reactant C-reactive protein is an important prognostic risk factor in patients with both stable and unstable coronary artery disease. The potential prognostic implications of an abnormal pre-procedural C-reactive protein concentration in patients undergoing elective coronary angioplasty may be relevant for subsequent treatment. METHODS AND RESULTS: Pre-procedural plasma levels of C-reactive protein were measured in 501 patients with stable coronary artery disease undergoing elective coronary angioplasty. The incidence of death or myocardial infarction during a 2-year follow-up was 10.6% (24/227) in patients with an increased C-reactive protein level (>3 mg. l(-1)) and 2.9% (8/274) in patients with a normal C-reactive protein level (RR 3.9, 95% CI 1.7-8.9). Survival without death, myocardial infarction, urgent revascularization or hospital admission for unstable angina was significantly lower in patients with an increased C-reactive protein vs patients with a normal C-reactive protein (log-rank 14.62, P<0.0001). Logistic regression analysis identified an increased C-reactive protein level as a strong independent predictor of event-free survival (RR 2.54, 95% CI: 1.44-4.47, P=0.001). CONCLUSION: Pre-procedural C-reactive protein levels are increased in 45% of patients undergoing elective coronary angioplasty. An increased C-reactive protein level is a powerful independent prognostic indicator for subsequent cardiac events, suggesting that late clinical outcome is markedly influenced by pre-procedural systemic activation of inflammation.
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Robbert de Winter (2002) conducted a cohort in stable coronary artery disease undergoing elective coronary angioplasty (n=501). Increased C-reactive protein (>3 mg/L) vs. Normal C-reactive protein was evaluated on death or myocardial infarction (RR 3.9, 95% CI 1.7-8.9). Increased pre-procedural C-reactive protein (>3 mg/L) in patients undergoing elective coronary angioplasty predicted a higher 2-year rate of death or MI compared to normal levels (10.6% vs 2.9%).
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