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European Heart Journal 2002 23(12):960-966; doi:10.1053/euhj.2001.2988
Copyright © 2002 by the European Society of Cardiology.
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The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty

R.J. de Wintera,f1, G.S. Heydea, K.T. Kocha, J. Fischerb, J.P. van Straalenb, M. Baxa, C.E. Schotborgha, K.J. Muldera, G.T. Sandersb, J.J. Pieka and J.G.P. Tijssena

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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