de Winter R J, Heyde G S, Koch K T, Fischer J, van Straalen J P, Bax M, Schotborgh C E, Mulder K J, Sanders G T, Piek J J, Tijssen J G P
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
Eur Heart J. 2002 Jun;23(12):960-6. doi: 10.1053/euhj.2001.2988.
The acute phase reactant C-reactive protein is an important prognostic risk factor in patients with both stable and unstable coronary artery disease. The potential prognostic implications of an abnormal pre-procedural C-reactive protein concentration in patients undergoing elective coronary angioplasty may be relevant for subsequent treatment.
Pre-procedural plasma levels of C-reactive protein were measured in 501 patients with stable coronary artery disease undergoing elective coronary angioplasty. The incidence of death or myocardial infarction during a 2-year follow-up was 10.6% (24/227) in patients with an increased C-reactive protein level (>3 mg. l(-1)) and 2.9% (8/274) in patients with a normal C-reactive protein level (RR 3.9, 95% CI 1.7-8.9). Survival without death, myocardial infarction, urgent revascularization or hospital admission for unstable angina was significantly lower in patients with an increased C-reactive protein vs patients with a normal C-reactive protein (log-rank 14.62, P<0.0001). Logistic regression analysis identified an increased C-reactive protein level as a strong independent predictor of event-free survival (RR 2.54, 95% CI: 1.44-4.47, P=0.001).
Pre-procedural C-reactive protein levels are increased in 45% of patients undergoing elective coronary angioplasty. An increased C-reactive protein level is a powerful independent prognostic indicator for subsequent cardiac events, suggesting that late clinical outcome is markedly influenced by pre-procedural systemic activation of inflammation.
急性期反应物C反应蛋白是稳定型和不稳定型冠状动脉疾病患者重要的预后风险因素。择期冠状动脉血管成形术患者术前C反应蛋白浓度异常的潜在预后意义可能与后续治疗相关。
对501例行择期冠状动脉血管成形术的稳定型冠状动脉疾病患者测定术前血浆C反应蛋白水平。C反应蛋白水平升高（>3mg·l⁻¹）的患者在2年随访期间死亡或心肌梗死的发生率为10.6%（24/227），C反应蛋白水平正常的患者为2.9%（8/274）（相对危险度3.9，95%可信区间1.7 - 8.9）。C反应蛋白水平升高的患者无死亡、心肌梗死、紧急血运重建或因不稳定型心绞痛住院的生存率显著低于C反应蛋白水平正常的患者（对数秩检验14.62，P<0.0001）。逻辑回归分析确定C反应蛋白水平升高是无事件生存的强有力独立预测因素（相对危险度2.54，95%可信区间：1.44 - 4.47，P = 0.001）。
45%的择期冠状动脉血管成形术患者术前C反应蛋白水平升高。C反应蛋白水平升高是后续心脏事件的有力独立预后指标，提示术前全身炎症激活对晚期临床结局有显著影响。
