Impact of high-sensitivity C-reactive protein on coronary artery disease severity and outcomes in patients undergoing percutaneous coronary intervention

Background: Inflammation plays a pivotal role in coronary artery disease (CAD). Few data from large-size studies are available on the association of high-sensitivity C-reactive protein (hs-CRP) and severity of CAD. Our aim was to investigate their relationship as well as their impact on long-term outcomes in patients undergoing percutaneous coronary intervention. Methods: In 2013, 10,020 patients were consecutively included. Patients were divided into three groups based on hs-CRP on admission: 0-3 mg/L (n = 6978, 69.6%), 3.01-10 mg/L (n = 1997, 19.9%), >10 mg/L (n = 1045, 10.4%). Disease severity was determined by SYNTAX score (SS). Their differences were assessed in SS and major adverse cardiovascular events (MACEs, including all-cause death, myocardial infarction, revascularization, and in-stent thrombosis) among groups. Results: The mean follow-up period was 874 days. Patients with elevated hs-CRP were older, had more risk factors such as hypertension, cerebrovascular disease, chronic obstructive pulmonary disease, and cigarette smoking. Multivariate regression analysis showed that hs-CRP > 10 mg/L (OR 1.49, 95% confidence interval 1.21-1.84, p < 0.001), age, previous myocardial infarction, serum creatinine, and left ventricular ejection fraction were independent predictors of intermediate-high SS (>22). Subgroup analysis indicated that the relation between hs-CRP and SS was also consistent in acute coronary syndrome and its subtypes. Although elevated hs-CRP was positively associated with increased rates of MACEs (11.0% versus 12.1% versus 14.3%, p = 0.006), death (1.0% versus 1.3% versus 3.0%, p < 0.001), and revascularization (8.6% versus 10.4% versus 10.0%, p = 0.032), it did not show any prognostic effect for adverse outcomes in multivariate regression analyses (all adjusted p > 0.05). While SS > 22 remained independently predictive of MACEs and revascularization after adjusting confounders, the risks of which were increased by 56% and 68%, respectively. Conclusion: Serum hs-CRP could be a useful biomarker for indicating CAD severity and could aid in risk stratification. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.