Adhesion molecules and C-reactive protein are associated to adverse events in angina pectoris

OBJECTIVES: To examine the prognostic value of soluble cellular adhesion molecules (CAMs) and highly sensitive C reactive protein (hsCRP) on long-term outcome for patients with stable angina pectoris (SAP). DESIGN: In a prospective study, 291 patients referred for coronary angiography due to clinically suspected SAP had serum level of soluble intercellular adhesion molecule-1 (sICAM-1), vascular adhesion molecule-1 (sVCAM-1), sP-selectin and hsCRP determined at baseline. The primary outcome was predefined as death from any cause, myocardial infarction or stroke during a mean follow-up of 7.1 years. RESULTS: Thirty four patients experienced the primary outcome. Hazard ratios and 95% confidence intervals for the primary outcome were: sVCAM-1: 2.4 [1.1-4.9], sICAM-1: 3.3 [1.5-7.2], sP-selectin: 1.2 [0.6-2.6] and hs-CRP: 3.1 [1.5-6.3], when comparing patients in the 4th quartile with those in lower quartiles in a multivariable model. Higher risk of adverse outcome was observed in patients having levels of both hsCRP and sICAM-1 (HR 4.7 [1.7-9.9]) or hsCRP and sVCAM-1 (HR 4.2 [1.7-9.9]) in the 4th quartile. CONCLUSIONS: sVCAM-1, sICAM-1 and hsCRP were significantly associated with long term outcomes of patients with SAP beyond the risk associated with traditional risk factors. Risk predictions were improved when combining information about sCAMs and hsCRP.