Different apparent prognostic value of hsCRP in type 2 diabetic and nondiabetic patients with acute coronary syndromes.
BACKGROUND
C-reactive protein (CRP) is an established prognostic marker in acute coronary syndromes (ACS); however, no study has specifically addressed its prognostic role in type 2 diabetes with ACS. We evaluated the prognostic role of CRP separately in diabetic and nondiabetic patients with ACS.


METHODS
We enrolled 251 patients with unstable angina and measured serum concentrations of high sensitivity (hs)CRP. Ninety-seven patients underwent coronary angiography with evaluation of atherosclerotic disease severity and extent by Bogaty score. Assessed endpoint was the combined occurrence of myocardial infarction (MI) and death at 1 year.


RESULTS
No significant differences were found in hs-CRP between patients with and without diabetes. By Cox regression, hsCRP was not associated with 1-year follow-up events in diabetic patients but was strongly associated with events in nondiabetic patients (P = 0.0012). Coronary angiography exhibited a higher extent index in patients with diabetes than in those without (P = 0.04). hsCRP concentrations were not associated with angiographic atherosclerotic burden. By Cox analysis, hsCRP and extent score were associated with events in patients who underwent coronary angiography (P < 0.001 and P = 0.034, respectively). In nondiabetic patients, hsCRP was the only predictor of events at 1-year follow-up (P < 0.001), whereas in diabetic patients, hsCRP was not associated with events and a weak association was observed for extent score (P = 0.06).


CONCLUSIONS
Our study suggests that different pathophysiological mechanisms may be responsible for MI and death in unstable angina patients with or without diabetes and that severity of coronary artery disease plays a major role in diabetes (and inflammation in the absence of diabetes).
Biasucci
Luigi M
LM
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. lmbiasucci@virgilio.it
Liuzzo
Giovanna
G
Della Bona
Roberta
R
Leo
Milena
M
Biasillo
Gina
G
Angiolillo
Dominick J
DJ
Abbate
Antonio
A
Rizzello
Vittoria
V
Niccoli
Giampaolo
G
Giubilato
Simona
S
Crea
Filippo
F
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000097:blood* / Q000150:complications / Q000175:diagnosis / Q000401:mortality; D002097:C-Reactive Protein / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012307:Risk Factors; D012720:Severity of Illness Index
D002097:C-Reactive Protein