C-reactive protein elevation and disease activity in patients with coronary artery disease

Aims We sought to assess (1) whether C-reactive protein (CRP) is an independent predictor of future cardiovascular events after adjustment for coronary artery disease (CAD) severity and (2) whether CRP levels correlate with number of angiographically complex coronary artery stenosis. Methods and results We studied 825 consecutive angina patients (mean age 63 10 years, 74% men), 700 with chronic stable angina (CSA) and 125 with acute coronary syndromes without ST-segment elevation (ACS). The composite endpoint of non-fatal acute myocardial infarction, hospital admission with class IIIb unstable angina and cardiac death was assessed at one year follow-up. Hs-CRP level was higher in CSA patients with the combined end-point (P = 0.03) after adjustment for number of diseased coronary arteries. Hs-CRP was also significantly higher in patients with ACS compared to CSA (P = 0.004) and correlated with number of complex angiographic stenoses (r = 0.36, P = 0.01). Hs-CRP was also increased in patients with NYHA functional class III or IV compared to those in class I or II (P < 0.0001). Conclusions CRP levels predict future cardiovascular events independently of CAD severity and correlate with number of angiographically complex coronary artery stenosis in patients with ACS. Thus, CRIP levels are a marker of atheromatous plaque vulnerability and CAD activity. (C) 2004 Published by Elsevier Ltd on behalf of The European Society of Cardiology.