Lanza Gaetano A, De Filippis Monica, Sestito Alfonso, Infusino Fabio, Maseri Attilio, Crea Filippo
Istituto di Cardiologia Università Cattolica del Sacro Cuore Policlinico A. Gemelli Largo A. Gemelli, 8 00168 Roma.
Ital Heart J. 2002 Nov;3(11):643-9.
Both exercise testing and C-reactive protein (CRP) serum levels have been shown to predict clinical events in patients with unstable angina. However, no previous study carefully compared their relative prognostic value in this clinical setting.
We reviewed data of 96 consecutive patients with unstable angina (77 males, 19 females, mean age 63.1 +/- 9.5 years), who were free from clinical events during hospital stay. A symptom/sign-limited treadmill exercise test had been performed and CRP serum levels had been measured prior to discharge in all patients.
During an average follow-up of 2.5 years (range 0.5-5 years), there were 8 major cardiac events (death or myocardial infarction) and 11 patients had recurrent unstable angina. Both exercise-induced myocardial ischemia [relative risk (RR) 3.02, 95% confidence interval (CI) 0.58-15.5, p = 0.29], and CRP levels > or = 10 mg/l (RR 2.4, 95% CI 0.51-11.2, p = 0.25) showed a non significant association with major cardiac events. Low workload ischemia, however, was significantly associated with major cardiac events (RR 8.58, 95% CI 1.66-44.2, p = 0.01) and was also the only predictive variable for the combined endpoint of major events and recurrent angina (RR 2.57, 95% CI 1.02-4.44, p = 0.045). Among patients with low workload ischemia, the occurrence of major events was higher in those with high, compared to those with low, CRP levels, but the difference was not significant (28.6 vs 15.4%, p = 0.64).
In this study, pre-discharge myocardial ischemia at low workload was the single most important predictor of major cardiac events during long-term follow-up among patients with stabilized unstable angina. Increased serum CRP levels did not add further significant prognostic information in this specific group of patients with unstable angina, although this issue needs to be addressed in larger studies.
运动试验和C反应蛋白（CRP）血清水平均已被证明可预测不稳定型心绞痛患者的临床事件。然而，此前尚无研究在这一临床环境中仔细比较它们的相对预后价值。
我们回顾了96例连续的不稳定型心绞痛患者（77例男性，19例女性，平均年龄63.1±9.5岁）的数据，这些患者在住院期间无临床事件发生。所有患者均进行了症状/体征受限的平板运动试验，并在出院前测量了CRP血清水平。
在平均2.5年（范围0.5 - 5年）的随访期间，发生了8例主要心脏事件（死亡或心肌梗死），11例患者出现复发性不稳定型心绞痛。运动诱发的心肌缺血[相对危险度（RR）3.02，95%可信区间（CI）0.58 - 15.5，p = 0.29]以及CRP水平≥10 mg/l（RR 2.4，95%CI 0.51 - 11.2，p = 0.25）与主要心脏事件的关联均无统计学意义。然而，低负荷量缺血与主要心脏事件显著相关（RR 8.58，95%CI 1.66 - 44.2，p = 0.01），并且也是主要事件和复发性心绞痛联合终点的唯一预测变量（RR 2.57，95%CI 1.02 - 4.44，p = 0.045）。在低负荷量缺血的患者中，CRP水平高的患者主要事件的发生率高于CRP水平低的患者，但差异无统计学意义（28.6%对15.4%，p = 0.64）。
在本研究中，出院前低负荷量的心肌缺血是稳定型不稳定型心绞痛患者长期随访期间主要心脏事件的唯一最重要预测因素。血清CRP水平升高在这一特定的不稳定型心绞痛患者组中并未增加更多显著的预后信息，尽管这一问题需要在更大规模的研究中加以探讨。
