C-reactive protein, clinical presentation, and ischemic activity in patients with chest pain and normal coronary angiograms.
OBJECTIVE
We sought to investigate the relationship among C-reactive protein (hs-CRP), clinical characteristics, exercise stress test responses, and ST-segment changes during daily life in patients with typical chest pain and normal coronary angiograms (CPNCA).


BACKGROUND
Patients with CPNCA have coronary microvascular endothelial dysfunction and myocardial ischemia. Elevated hs-CRP levels have been related to atherogenesis and endothelial dysfunction. The relationship between hs-CRP and disease activity has not been previously investigated in CPNCA patients.


METHODS
We studied 137 consecutive CPNCA patients (mean age, 57 +/- 9; 33 men). All completed standardized angina questionnaires, underwent exercise stress testing, 24-h ambulatory electrocardiogram (ECG) monitoring (Holter), and hs-CRP measurements at study entry.


RESULTS
C-reactive protein levels (mg/l) were higher in patients with frequent (2.9 +/- 3.3) and prolonged (3.9 +/- 4.1) chest pain episodes, and in those with ST-segment depression on exercise testing (2.6 +/- 2.8) and Holter monitoring (3.4 +/- 3.1) compared with patients with occasional (1.3 +/- 1.2; p = 0.002) or shorter chest pain (1.5 +/- 1.3; p < 0.001) episodes, negative exercise stress testing (1.1 +/- 1.1; p < 0.001), and no ST-segment shifts on Holter monitoring (0.9 +/- 0.7; p < 0.001). Moreover, we found a correlation between hs-CRP concentration and number of ischemic episodes during Holter monitoring (r = 0.65; p < 0.001) and with the magnitude of ST-segment depression on exercise testing (r = -0.43; p < 0.001). The hs-CRP was the only independent variable (multivariate logistic regression) capable of predicting positive findings on Holter monitoring (odds ratio [OR], 3.8; confidence interval [CI], 2.3 to 6.2) and exercise testing (OR, 1.7; CI, 1.2 to 2.2).


CONCLUSIONS
The hs-CRP correlates with symptoms and ECG markers of myocardial ischemia in CPNCA patients. Whether hs-CRP is related to the pathogenesis of angina in these patients deserves further investigation.
Coronary Artery Disease Research Unit, Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Juan
J
Cosín-Sales
Carmine
C
Pizzi
Sue
S
Brown
Juan Carlos
JC
Kaski
D000328:Adult; D002097:C-Reactive Protein / Q000032:analysis*; D017023:Coronary Angiography; D015716:Electrocardiography, Ambulatory; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood* / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012720:Severity of Illness Index
D002097:C-Reactive Protein