title: High-sensitivity C-reactive protein predicts cardiovascular events and myocardial damage after vascular surgery.
abstract: OBJECTIVE
  To assess the association of high-sensitivity C-reactive protein (hsCRP) to adverse cardiovascular events and perioperative myocardial damage in patients after elective vascular surgery.
  
  
  METHODS
  This was a prospective observational study in a tertiary-care teaching hospital, with 239 patients undergoing elective vascular surgery. The receiver-operating characteristic (ROC) curve was calculated to assess the optimal cut-off value of hsCRP. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Multiple logistic regression analysis was used to identify the predictors of the primary outcome. The primary outcome was a composite of periprocedural myocardial damage, defined as cardiac troponin I (cTn-I) elevation above the decision limit of 0.15 μg/L, death, acute coronary syndrome, stroke, acute heart failure, or intrastent thrombosis within 30 days of surgery.
  
  
  RESULTS
  On ROC analysis, the optimal cut-off value of hsCRP was 3.2 mg/L. The primary outcome occurred in 48 patients (20.1%). On univariate analysis, smoking (P = .009), known hypercholesterolemia (P = .01), previous ischemic heart disease (P = .0003), open surgery (P = .03), and hsCRP levels (P < .0001) were associated with the primary outcome. On multiple logistic regression analysis, only hsCRP was independently associated with the primary outcome. The unadjusted and adjusted ORs for the primary outcome among patients with hsCRP levels >3.2 mg/L were 7.5 (CI, 3.7-15.2; P < .0001) and 4.6 (CI, 2.1-9.9; P = .0001), respectively.
  
  
  CONCLUSIONS
  Our data suggest that higher levels of hsCRP are independently associated with an increased risk of perioperative myocardial damage and early adverse cardiovascular events in patients undergoing elective vascular surgery. This may have implications for risk stratification and therapeutic approach.
authors: Division of Cardiology and Cardiac Rehabilitation, S. Maugeri Foundation, Institute of Cassano Murge, Bari, Italy. domenico.scrutinio@fsm.it
authors: Domenico
authors: D
authors: Scrutinio
authors: Andrea
authors: A
authors: Passantino
authors: Francesca
authors: F
authors: Di Serio
authors: Domenico
authors: D
authors: Angiletta
authors: Daniela
authors: D
authors: Santoro
authors: Guido
authors: G
authors: Regina
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood; D015854:Up-Regulation; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein