Prognostic Impact Of High Sensitivity C-reactive Protein In Patients With Unstable Angina (UA)

BackgroundCoronary heart disease (CHD) is the leading cause of death for both men and women and accounts for approximately 600,000 deaths in the United States every year. In China, the prevalence of cardiovascular disease patients continues increasing, the total prevalence now stands at 230 millions; on average, among 5 adults persons 1 has heart disease. In worldwide, every year 350 millions persons die from cardiovascular disease.Increased high-sensitivity C-reactive protein (hs-CRP) has been associated with CVD, in those presenting after an acute coronary event, and also in apparently healthy individuals. hs-CRP is a marker of inflammation that predicts incident myocardial infarction, stroke, peripheral arterial disease, and sudden cardiac death among healthy individuals with no history of cardiovascular disease, and recurrent events and death in patients with acute or stable coronary syndromes. Elevated hs-CRP has been found to correlate with higher risk for cardiac events in patients with coronary disease. hs-CRP levels of less than 1,1 to 3, and greater than 3 mg/L are associated with lower, moderate, and higher cardiovascular risks, respectively.ObjectivesTo investigate the prognostic value of hs-CRP elevation in a large population with unstable angina; evaluate hs-CRP as predictors of risk of the individual end points of mortality and myocardial infarction (MI) in patients with unstable angina (UA).MethodsThe study involved 220 subjects admitted to Zhongda Hospital affiliated to Southeast University, department of cardiology between October 2012 to December 2014 with a clinical diagnosis of unstable angina, defined as angina at rest, recent onset, or crescendo angina with chest pain within the previous 48 hours, were considered eligible for the study. Patients with myocardial infarction at admission or with myocardial infarction within the previous 2 months (n=52) were excluded, as well as patients with a known malignancy or inflammatory disease or missing biological samples (n=27). Therefore,141 patients with unstable angina were prospectively included. Of these,54 had abnormal hs-CRP value (hs-CRP≥3.0 mg/L). The other 87 subjects had normal hs-CRP value (hs-CRP<3.0 mg/L). hs-CRP value was assessed on admission.Major adverse cardiac events were defined as follows:(1) death, (2) acute myocardial infarction, and (3) the need for emergency coronary angioplasty or coronary bypass graft surgery because of failure of medical therapy to control ischemic episodes. No patient was treated by angioplasty or coronary bypass graft surgery within the first 24 hours. The risk for major events (death or nonfatal myocardial infarction) through 1 year of follow-up was analyzed and Information on age, sex, smoking habit, hypertension, hypercholesterolemia and diabetes was obtained from the medical record. Patients with age > 75 years old, end-stage renal disease, recent surgery, recent trauma, patients with LVEF< 0.4, as well as patients with a known malignancy or inflammation disease or missing biological sample were excluded; patients were followed until discharge. Baseline high-sensitivity C-reactive protein levels were compared between patients with abnormal hs-CRP(≥3.0 mg/L) and patients with normal hs-CRP(<3.0 mg/L). Statistical analyses were conducted using SPSS software comparing major adverse cardiovascular events (MACEs) between the two groups.Results1. Triglyceride TG rate in hs-CRP(≥3.0 mg/L) group is higher than in hs-CRP(<3.0 mg/L) group (P= 0.032); age rate in hs-CRP(≥3.0 mg/ml)group is higher than in (hs-CRP<3.0 mg/ml) group(P=0.012); left ventricular ejection fraction LVEF rate in hs-CRP(≥3.0 mg/L) group is higher than in hs-CRP<3.0 mg/ml group (P=0.000); hs C-reaction protein rate in hs-CRP(≥3.0 mg/L) group is higher than in hs-CRP(<3.0 mg/L) group (P=0.000),2. After 1 year of follow up, Major adverse cardiovascular events was determined; the findings were as following:The rate of AMI in hs-CRP(≥3.0mg/L) group is 3.7%; the rate of AMI in hs-CRP(<3.0mg/L) group is 1.15%(P=0.028); the rate of revascularization in hs-CRP(≥3.0mg/L) group is 28.4%, the rate of coronary revascularization in hs-CRP(<3.0mg/L) group is 20.7%(P=0.01); the rate of angina needing hospital admission in hs-CRP(≥=3.0mg/L) group is 9.9%, the rate of angina needing hospital admission in hs-CRP(<3.0mg/L) group is 5.7%(P=0.035).There is no obvious statistical difference between the two groups based on cardiac death (P>0.05)ConclusionAlterations in inflammation as measured by elevated hs-CRP-levels in a large population are associated with increased risk for cardiovascular morbidity and mortality. Evaluation of hs-CRP levels at the time of admission should be included in the assessment of the patient including clinical setting, associated diseases, markers of myocardial necrosis (especially troponin levels), LV function, and age. Cutoff levels for hs-CRP should be judged on the basis of the clinical scenario (in particular if myocardial necrosis is present) and in consideration of the end point of interest. Patients with elevated hs-CRP levels do worse at the short-and long-term follow-up and hs -CRP levels can be used as prognostic indicator.