High-sensitivity C-reactive protein and plaque composition in patients with stable angina pectoris: a virtual histology intravascular ultrasound study

OBJECTIVE: Elevated high-sensitivity C-reactive protein (hs-CRP) is related to clinical outcome in coronary artery disease. We used virtual histology intravascular ultrasound to evaluate the relationship between serum hs-CRP level and coronary plaque composition in patients with stable angina pectoris. METHODS AND RESULTS: Overall 113 consecutive patients with stable angina pectoris who had a de-novo culprit lesion were examined in this study. Patients were divided into an elevated hs-CRP group (>3 mg/l; n=40) or a normal hs-CRP group (n=73). Grayscale and virtual histology intravascular ultrasound analysis was performed across the entire culprit lesion. Mean plaque area was similar in both groups. Lesion length (18+/-5 vs. 16+/-6 mm, P<0.046) was significantly greater in the elevated hs-CRP group than that in the normal hs-CRP group. Although the percentage of dense calcium, fibrofatty tissue, and fibrous tissue was not different between the two groups, the percentage of necrotic core was significantly greater in the elevated hs-CRP group compared with the normal hs-CRP group (20+/-9 vs. 16+/-8%, P=0.014). The percentage of necrotic core was positively correlated with the serum hs-CRP level (r=0.20, P=0.037). A multivariate logistic regression model showed that the percentage of necrotic core was associated with elevated hs-CRP (P=0.019; odds ratio=1.1; 95% confidence interval=1.01-1.12). CONCLUSION: Elevated hs-CRP was related to the amount of necrotic core in the culprit lesion of stable angina pectoris. Our results suggest that elevated hs-CRP might reflect the inflammatory activity of the coronary atherosclerotic plaque even in the setting of stable angina pectoris.