The prognostic value of high-sensitivity C-reactive protein (hsCRP) in complex coronary artery disease has not been fully established. We aimed to determine the association between hsCRP and long-term outcomes in elderly patients with 3-vessel disease (TVD). From April 2004 to February 2011, 3069 patients aged ≥65 years with TVD were consecutively enrolled and received medical treatment alone, percutaneous coronary intervention, or coronary artery bypass grafting. The patients were divided into 2 groups according to their hsCRP levels: <3.00 mg/L (62.1%) and ≥3.00 mg/L (37.9%). The mean age was 71 ± 4 years. The high hsCRP group had more risk factors and more frequently received conservative treatment than the low hsCRP group. During a median follow-up period of 6.2 years, elevated hsCRP was significantly associated with increased all-cause death (19.5% vs 29.6%, P < .001), cardiac death (9.4% vs 15.2%, P = .001), and major adverse cardiovascular and cerebrovascular events (34.1% vs 42.5%, P = .001). Multivariable Cox regression analyses revealed that hsCRP was an independent predictor for all of these events. Combining hsCRP with Synergy between PCI with TAXUS and Cardiac Surgery score II further improved the predictive power of the score. The relationship between hsCRP and mortality was relatively consistent across subgroups. Overall, hsCRP could prove useful for risk prediction in elderly patients.
D’AscenzoFPresuttiDGPicardiE, et al.Prevalence and non-invasive predictors of left main or three-vessel coronary disease: evidence from a collaborative international meta-analysis including 22 740 patients. Heart. 2012;98:914–9.
2.
LinderRZeidlerJVerheyenFvon der SchulenburgJGHaverichASchillingT. Guidelines versus reality: is coronary stent application in three-vessel disease standard or the exception?. Eur J Health Econ. 2018;19:821–30.
3.
FihnSDGardinJMAbramsJ, et al.2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–164.
4.
NeumannFJSousa-UvaMAhlssonA, et al.2018 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2019;40:87–165.
5.
EscanedJBanningAFarooqV, et al.Rationale and design of the SYNTAX II trial evaluating the short to long-term outcomes of state-of-the-art percutaneous coronary revascularisation in patients with de novo three-vessel disease. EuroIntervention. 2016;12:e224–34.
6.
EscanedJColletCRyanN, et al.Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J. 2017;38:3124–34.
7.
RencuzogullariIÇağdaşMKarabağY, et al.Value of syntax score II for predicting in-hospital and long-term survival in octogenarians with ST-segment elevation myocardial infarction: A comparison of six different risk scores. Arch Gerontol Geriatr. 2019;83:37–43.
8.
FriedLSolomonCShlipakM, et al.Inflammatory and prothrombotic markers and the progression of renal disease in elderly individuals. J Am Soc Nephrol. 2004;15:3184–91.
9.
SuzukiTKatzRJennyNS, et al.Metabolic syndrome, inflammation, and incident heart failure in the elderly: the cardiovascular health study. Circ Heart Fail. 2008;1:242–8.
10.
KollerLKleberMGoliaschG, et al.C-reactive protein predicts mortality in patients referred for coronary angiography and symptoms of heart failure with preserved ejection fraction. Eur J Heart Fail. 2014;16:758–66.
11.
CarreroJJAndersson FrankoMObergfellAGabrielsenAJernbergT. hsCRP Level and the Risk of Death or Recurrent Cardiovascular Events in Patients With Myocardial Infarction: a Healthcare-Based Study. J Am Heart Assoc. 2019;8:e012638.
12.
BentzonJFOtsukaFVirmaniRFalkE. Mechanisms of plaque formation and rupture. Circ Res. 2014;114:1852–66.
13.
CreaFLibbyP.Acute Coronary Syndromes: The Way Forward From Mechanisms to Precision Treatment. Circulation. 2017;136:1155–66.
14.
ScaloneGNiccoliGRefaatH, et al.Not all plaque ruptures are born equal: an optical coherence tomography study. Eur Heart J Cardiovasc Imaging. 2017;18:1271–7.
15.
YousufOMohantyBDMartinSS, et al.High-sensitivity C-reactive protein and cardiovascular disease: a resolute belief or an elusive link?J Am Coll Cardiol, 2013, 62: 397–408.
16.
SongYGaoZTangX, et al.Impact of residual SYNTAX score on clinical outcomes after incomplete revascularisation percutaneous coronary intervention: a large single-centre study. EuroIntervention. 2017;13:1185–93.
17.
ÇınarTÇağdaşMRencüzoğullarıİ, et al.Prognostic efficacy of C-reactive protein/albumin ratio in ST elevation myocardial infarction. Scand Cardiovasc J. 2019;53:83–90.
18.
PencinaMJD’AgostinoRBSrSteyerbergEW. Extensions of net reclassification improvement calculations to measure usefulness of new biomarkers. Stat Med. 2011;30:11–21.
19.
WadaHDohiTMiyauchiK, et al.Preprocedural High-Sensitivity C-Reactive Protein Predicts Long-Term Outcome of Percutaneous Coronary Intervention. Circ J. 2016;81:90–5.
20.
EldrupNKragelundCSteffensenRNordestgaardBG. Prognosis by C-reactive protein and matrix metalloproteinase-9 levels in stable coronary heart disease during 15 years of follow-up. Nutr Metab Cardiovasc Dis. 2012;22:677–83.
21.
GrootHEKarperJCLipsicEvan VeldhuisenDJvan der HorstICCvan der HarstP. High-sensitivity C-reactive protein and long term reperfusion success of primary percutaneous intervention in ST-elevation myocardial infarction. Int J Cardiol. 2017;248:51–6.
22.
HanSSKimDKKimSChinHJChaeDWNaKY. C-Reactive Protein Predicts Acute Kidney Injury and Death After Coronary Artery Bypass Grafting. Ann Thorac Surg. 2017;104:804–10.
23.
VanhaverbekeMVeltmanDPattynN, et al.C-reactive protein during and after myocardial infarction in relation to cardiac injury and left ventricular function at follow-up. Clin Cardiol. 2018;41:1201–6.
24.
PokharelYSharmaPPQintarM, et al.High-sensitivity C-reactive protein levels and health status outcomes after myocardial infarction. Atherosclerosis. 2017;266:16–23.
25.
JialalIDevarajSVenugopalSK. C-reactive protein: risk marker or mediator in atherothrombosis?Hypertension. 2004;44:6–11.
26.
DevarajSJialalI. C-reactive protein polarizes human macrophages to an M1 phenotype and inhibits transformation to the M2 phenotype. Arterioscler Thromb Vasc Biol. 2011;31:1397–402.
27.
StancelNChenCCKeLY, et al.Interplay between CRP, Atherogenic LDL, and LOX-1 and Its Potential Role in the Pathogenesis of Atherosclerosis. Clin Chem. 2016;62:320–7.
28.
KhreissTJozsefLPotempaLAFilepJG. Opposing effects of C-reactive protein isoforms on shear-induced neutrophil-platelet adhesion and neutrophil aggregation in whole blood. Circulation. 2004;110:2713–2720.
29.
ElliottPChambersJCZhangW, et al.Genetic Loci associated with C-reactive protein levels and risk of coronary heart disease. JAMA. 2009;302:37–48.
30.
WensleyFGaoPBurgessS, et al.Association between C reactive protein and coronary heart disease: mendelian randomisation analysis based on individual participant data. BMJ. 2011;342:d548.
31.
RidkerPMEverettBMThurenT, et al.Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. N Engl J Med. 2017;377:1119–31.
32.
RidkerPMMacFadyenJGEverettBMLibbyPThurenTGlynnRJ. Relationship of C-reactive protein reduction to cardiovascular event reduction following treatment with canakinumab: a secondary analysis from the CANTOS randomised controlled trial. Lancet. 2018;391:319–28.
33.
TaoTWangHWangSXGuoYTZhuPWangYT. Long-term outcomes of high-risk elderly male patients with multivessel coronary disease: optimal medical therapy versus revascularization. J Geriatr Cardiol. 2016;13:152–7.
34.
RoeMTLiSThomasL, et al.Long-term outcomes after invasive management for older patients with non-ST-segment elevation myocardial infarction. Circ Cardiovasc Qual Outcomes. 2013;6:323–32.
35.
FlatherMRheeJ-WBoothroydDB, et al.The Effect of Age on Outcomes of Coronary Artery Bypass Surgery Compared With Balloon Angioplasty or Bare-Metal Stent Implantation Among Patients With Multivessel Coronary Disease: A Collaborative Analysis of Individual Patient Data From 10 Randomized Trials. J Am Coll Cardiol. 2012;60:2150–7.
36.
BreenKFinneganLVuckovicKFinkARosamondWDeVonHA. Multimorbidity in Patients With Acute Coronary Syndrome Is Associated With Greater Mortality, Higher Readmission Rates, and Increased Length of Stay: A Systematic Review. J Cardiovasc Nurs. 2020;35: e99–110.
37.
HallMDondoTBYanAT, et al.Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: Latent class analysis of a nationwide population-based cohort. PLOS Med. 2018;15:e1002501.
38.
ThuijsDJFMKappeteinAPSerruysPW, et al.Percutaneous coronary intervention versus coronary artery bypass grafting in patients with three-vessel or left main coronary artery disease: 10-year follow-up of the multicentre randomised controlled SYNTAX trial. Lancet. 2019;394:1325–34.
39.
MilojevicMHeadSJParascaCA, et al.Causes of Death Following PCI Versus CABG in Complex CAD: 5-Year Follow-Up of SYNTAX. J Am Coll Cardiol. 2016;67:42–55.
40.
RidkerPMDanielsonEFonsecaFA, et al.Reduction in C-reactive protein and LDL cholesterol and cardiovascular event rates after initiation of rosuvastatin: a prospective study of the JUPITER trial. Lancet. 2009;373:1175–82.
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