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European Heart Journal Advance Access published online on March 30, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi192
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received September 27, 2004
Revised December 30, 2005
Accepted February 3, 2005

Clinical research

Increased circulating C-reactive protein and macrophage-colony stimulating factor are complementary predictors of long-term outcome in patients with chronic coronary artery disease

Ignatios Ikonomidis 1*, John Lekakis 1, Ioanna Revela 1, Felicita Andreotti 2, and Petros Nihoyannopoulos 2

1 Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Vas. Sofias 80, Athens 11528, Greece
2 Imperial College School of Medicine, National Heart & Lung Institute, Cardiology Department, Hammersmith Hospital, London, UK

* To whom correspondence should be addressed.
Ignatios Ikonomidis, E-mail: ignoik{at}otenet.gr


  Abstract

Aims We investigated, in a 6 year follow-up study, whether circulating levels of C-reactive protein (CRP) and macrophage colony stimulating factor (MCSF) have an independent or complementary prognostic value in patients with chronic coronary artery disease (CAD).

Methods and results MCSF and CRP were measured in 100 patients with chronic CAD. Of 95 (33%) patients, 31 who completed the 6 year follow-up presented adverse events (death, myocardial infarction, and unstable angina). In multivariable analysis (including traditional risk factors and medications), the upper tertiles of MCSF (≥814 pg/mL) and CRP (≥2.5 mg/L) levels were independently associated with a 13- and 6-fold increase in risk of events, respectively (P < 0.01). Patients with combined high CRP and MCSF had a higher absolute risk of events than patients with elevated MCSF or CRP alone (75 vs. 59 vs. 32%, respectively, P < 0.01). The mean event-free time was 39, 64, and 52 months in patients with elevated MCSF, elevated CRP, and their combination, respectively.

Conclusion In patients with chronic CAD, the prognostic value of MCSF is independent and complementary to that of CRP. MCSF is a particularly useful prognostic marker when CRP levels are low, but also provides additional information concerning risk and time-course of events in patients with elevated CRP.

Keywords: Inflammation; Coronary artery disease; Long-term prognosis.
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