Incremental prognostic value of high-sensitive C-reactive protein in patients undergoing coronary computed tomography angiography.
This study was performed to investigate whether combined use of high-sensitivity C-reactive protein (hs-CRP) levels and coronary computed tomography angiography (CCTA) results have additional prognostic value for predicting cardiovascular events in patients with suspected coronary artery disease (CAD).



A total of 445 patients (61.6±9.3 years and 62.9% men) with suspected CAD who underwent both CCTA and hs-CRP measurement within one month were evaluated. Information on cardiovascular events, including cardiac death, non-fatal myocardial infarction, unstable angina and late (≥six months after CCTA) coronary revascularization was assessed.



One hundred and eighty-five patients (41.6%) had obstructive CAD on CCTA (stenosis ≥50%). Both high hs-CRP (≥2.25mg/L) and obstructive CAD were the independent predictors of cardiovascular events. Kaplan-Meier analysis showed that event rates were significantly different according to the presence of obstructive CAD and hs-CRP levels. Addition of hs-CRP levels to combined information of clinical factors and CCTA results further increased the predictive power for cardiovascular events (global chi-square ratio, from 13.51 to 19.14, p=0.022). Event risks were approximately 21.0-fold higher in the highest-risk group with both obstructive CAD and high hs-CRP levels than in the lowest-risk group with both insignificant CAD and low hs-CRP levels (p=0.007).



Combined use of hs-CRP levels and CCTA results provided a significant improvement in prognostic power for cardiovascular events in patients with suspected CAD. hs-CRP measurement may be a simple and useful method for determining risk stratification and treatment strategy in patients undergoing CCTA.
Division of Cardiology, Kangdong Sacred Heart Hospital, Seoul, Republic of Korea; Hallym University College of Medicine, Seoul, Republic of Korea.
Won-Woo
WW
Seo
Division of Cardiology, Boramae Medical Center, Seoul, Republic of Korea; Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: khl2876@gmail.com.
Hack-Lyoung
HL
Kim
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea.
Yong-Jin
YJ
Kim
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Yeonyee E
YE
Yoon
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea.
Seung-Pyo
SP
Lee
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea.
Hyung-Kwan
HK
Kim
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Goo-Yeong
GY
Cho
Division of Cardiology, Boramae Medical Center, Seoul, Republic of Korea; Seoul National University College of Medicine, Seoul, Republic of Korea.
Joo-Hee
JH
Zo
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
Dong-Ju
DJ
Choi
Seoul National University College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea.
Dae-Won
DW
Sohn
D000789:Angina, Unstable / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D000072226:Computed Tomography Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000000981:diagnostic imaging*; D054059:Coronary Occlusion / Q000000981:diagnostic imaging / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009204:Myocardial Revascularization; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
D015415:Biomarkers; D002097:C-Reactive Protein
Coronary computed tomography angiography; High-sensitivity C-reactive protein; Prognosis