C-reactive protein and angiographic coronary artery disease: Independent and additive predictors of risk in subjects with angina
C-reactive protein and angiographic coronary artery disease: Independent and additive predictors of risk in subjects with angina
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DOI：
10.1016/s0735-1097(01)01804-6
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发表时间：
2002-02-20
影响因子：
24
通讯作者：
Anderson, JL
中科院分区：
文献类型：
--
作者：
Zebrack, JS;Muhlestein, JB;Anderson, JL
目的：本研究的目的是确定独立于冠状动脉造影结果的c反应蛋白（CRP）的预后价值。背景：高敏感性CRP是一种炎症标志物，可预测心血管事件的风险。然而，一旦考虑到血管造影结果，尚不确定它是否仍然具有预测性。方法对2554例心绞痛但无急性心肌梗死（MI）的患者进行血管造影研究；1,848例患者有冠状动脉疾病（CAD）， 706例患者没有。冠状动脉疾病以五种方式量化，并合并为CAD评分。c -反应蛋白与冠心病程度相关，但相关系数较低（0.02 ~ 0.08）。在血管造影测量中，CAD评分最能预测未来事件（风险比[HR] = 1.8[1.2至2.6],p = 0.004，对于CAD评分为bbbb4）。c -反应蛋白大于或等于1.0 mg/dl对非CAD患者（HR = 2.3 [0.9 ~ 5.5], p = 0.07）和CAD患者（HR = 2.1 [1.5 ~ 3.1], p = 0.0001）均具有预测意义。多因素调整导致HR变化不大。c -反应蛋白在CAD评分的每个五分位数内保持预测价值。c -反应蛋白和CAD独立和共同促进了风险预测：低CRP和最低CAD评分与最低风险相关，高CRP和最高CAD评分与最高风险相关，极值差异为10倍（2.5%对24%）。结论c反应蛋白与冠心病程度相关，但相关程度较低。CAD和CRP的严重程度/程度是独立的和附加的风险预测因子。治疗应针对crp相关的风险以及血管造影显示的狭窄。(C) 2002年由美国心脏病学会提出。
OBJECTIVES The objective of this study was to determine the prognostic value of C-reactive protein (CRP) independent of coronary angiographic findings.BACKGROUND High sensitivity CRP, a marker of inflammation, predicts risk of cardiovascular events. However, it is uncertain whether it remains predictive once angiographic findings are considered.METHODS A total of 2,554 patients with angina but without acute myocardial infarction (MI) were studied angiographically; 1,848 patients had coronary artery disease (CAD) and 706 patients did not. Coronary artery disease was quantified in five ways and combined for a CAD score. C-reactive protein was measured and patients were followed for up to five years for death or MI.RESULTS C-reactive protein correlated with the extent of CAD, but correlation coefficients were low (0.02 to 0.08). Of angiographic measures, the CAD score best predicted future events (hazard ratio [HR] = 1.8 [1.2 to 2.6], p = 0.004, for CAD score >4). C-reactive protein greater than or equal to1.0 mg/dl was predictive in both patients without CAD (HR = 2.3 [0.9 to 5.5], p = 0.07) and with CAD (HR = 2.1 [1.5 to 3.1], p = 0.0001). Multivariate adjustment resulted in little change in HR. C-reactive protein retained predictive value within each quintile of CAD score. C-reactive protein and CAD independently and additively contributed to the risk prediction: low CRP and lowest CAD score was associated with lowest risk, and high CRP and highest CAD score was associated with the highest risk, with a 10-fold difference between extremes (2.5% vs. 24%).CONCLUSIONS C-reactive protein correlates with extent of CAD, but the degree of correlation is low. Severity/extent of CAD and CRP are independent and additive predictors of risk. Therapy should target CRP-associated risk as well as angiographically evident stenosis. (C) 2002 by the American College of Cardiology.