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.
Cosín-Sales
Juan
J
Coronary Artery Disease Research Unit, Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Pizzi
Carmine
C
Brown
Sue
S
Kaski
Juan Carlos
JC
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