Copyright © 2002 by the European Society of Cardiology.
The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty
a Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
b Department of Clinical Chemistry, Academic Medical Center, University of Amsterdam, The Netherlands
revised September 5, 2001; accepted September 6, 2001
Abstract
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 (>3mg.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.
Key Words: Inflammation, coronary angioplasty, prognosis, angina pectoris
f1 Correspondence: Robbert J. de Winter, MD PhD, Department of Cardiology, B2-137, Academic Medical Center, Meibergdreef 9, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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