The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty.
OBJECTIVE
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.


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 (>3 mg. 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).


CONCLUSIONS
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.
de Winter
R J
RJ
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
Heyde
G S
GS
Koch
K T
KT
Fischer
J
J
van Straalen
J P
JP
Bax
M
M
Schotborgh
C E
CE
Mulder
K J
KJ
Sanders
G T
GT
Piek
J J
JJ
Tijssen
J G P
JG
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000378:metabolism / Q000628:therapy; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000209:etiology / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D010343:Patient Admission; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome
D015415:Biomarkers; D002097:C-Reactive Protein