title: The Impact of Biochemical Markers on Major Adverse Cardiovascular Events and Contralateral Carotid Artery Stenosis Progression Following Carotid Interventions.
abstract: BACKGROUND
  To determine if elevated preintervention high-sensitivity C-reactive protein (hsCRP) and B-type natriuretic peptide (BNP) levels associate with major adverse cardiovascular events (MACE) or disease progression after carotid revascularization.
  
  
  METHODS
  We retrospectively examined patients receiving elective carotid endarterectomy (CEA) or carotid artery stenting (CAS) at our institution from 2007 to 2014. All included patients had preintervention hsCRP and BNP levels. Examined outcomes of interest included contralateral carotid disease progression (increased stenosis or need for revascularization) and MACE (composite of death, stroke, myocardial infarction, need for coronary artery bypass graft or percutaneous coronary intervention) at 3 years after procedure. The relationship between baseline hsCRP and BNP levels and time to event was examined by univariate and multivariate Cox proportional hazard regression analyses.
  
  
  RESULTS
  A total of 248 patients were included in the analysis (mean age: 68 ± 10 years), with 14% receiving CAS and 86% CEA. A total of 61 patients (25%) had 1 or more MACE by 3 years. Elevated hsCRP (>3 mg/L) trended toward associating with MACE but failed to reach significance (hazard ratio [HR]: 1.6 [1.0-2.7], P = 0.07). Multivariate analysis found that elevated BNP (>100pg/mL, HR: 2.2 [1.3-3.7], P = 0.002) and diabetes mellitus (HR: 1.9 [1.2-3.2], P = 0.01) predicted MACE. Having elevated preprocedural levels of both hsCRP and BNP significantly increased patients' likelihood of experiencing MACE (HR: 3.4 [1.6-7.1], P = 0.001). About 175 patients received contralateral carotid imaging postprocedure and of those patients, 31 (18%) experienced stenosis progression and/or revascularization within 3 years. However, neither elevated hsCRP (HR: 1.2 [0.6-2.3], P = 0.68) nor BNP (HR: 1.1 [0.5-2.5], P = 0.88) associated with disease progression.
  
  
  CONCLUSIONS
  BNP elevation at the time of carotid intervention is associated with MACE in long-term follow-up. hsCRP does not appear to correlate with either disease progression of the contralateral artery or MACE.
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV. Electronic address: pstone0627@yahoo.com.
authors.forename: Patrick Alan
authors.initials: PA
authors.lastname: Stone
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
authors.forename: Stephanie N
authors.initials: SN
authors.lastname: Thompson
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: Mija
authors.initials: M
authors.lastname: Khan
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Northfield
authors.affiliation: Division of Vascular and Endovascular Surgery, West Virginia University, Charleston, WV.
authors.forename: Rachel
authors.initials: R
authors.lastname: Schillinger
authors.affiliation: Charleston Area Medical Center Health Education and Research Institute, Charleston, WV.
authors.forename: Paulina
authors.initials: P
authors.lastname: Skaff
mesh_terms: D000368:Aged; D017130:Angioplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000401:mortality / Q000628:therapy*; D018450:Disease Progression; D016894:Endarterectomy, Carotid / Q000009:adverse effects* / Q000401:mortality; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation; D014903:West Virginia
chemical_list: D015415:Biomarkers; D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein