Centre d'Exploration, de Prévention et de Traitement de l'Athéroclérose, Hôpital Cardiologique, CHU de Bordeaux, Université Bordeaux Segalen, Pessac, France.
Eur J Prev Cardiol. 2012 Oct;19(5):1128-37. doi: 10.1177/1741826711420347. Epub 2011 Sep 7.
High-sensitivity C-reactive protein (hsCRP) has been reported to have a prognostic value immediately after acute coronary syndrome (ACS) and to be associated with the onset of cardiovascular (CV) events in patients with stable and unstable angina pectoris.
To evaluate whether or not hsCRP levels can be used to predict future CV events in a prospective study of post-ACS patients receiving an optimized medical treatment (OMT) secondary-prevention regimen.
OMT along with therapeutic and dietary education programmes were started during the acute phase, then monitored and adjusted as needed at 3 months post ACS. hsCRP was measured at 3 months after the ACS, and a global evaluation of atherosclerosis burden and risk factors were also evaluated at this time point. The study population was divided into tertiles based on their hsCRP value and followed for CV events.
A total of 1202 consecutive patients with hsCRP <15 mg/l were included in the study, 795 of which were followed for an average of 22 months. LDL-cholesterol, HbA(1c), waist circumference, systolic blood pressure, metabolic syndrome, tobacco consumption, and atherosclerosis burden were higher in patients in the second and third tertile of hsCRP (p < 0.001) than those in the first tertile, at 3 months. hsCRP level was not found to be associated with recurrence of total CV events (HR 1.29, CI 0.83-2.00) in univariate analysis. We further examined the effect of adding hsCRP levels to the Framingham risk evaluation score, and found no significant improvement the C-statistics of the Framingham risk evaluation score.
hsCRP is associated with CV risk factors, but is not an independent predictor of future events in post-ACS patients receiving an OMT secondary-prevention regimen.
高敏 C 反应蛋白（hsCRP）已被报道在急性冠状动脉综合征（ACS）后具有预后价值，并与稳定型和不稳定型心绞痛患者心血管（CV）事件的发生相关。
评估 hsCRP 水平是否可用于预测 ACS 后接受优化药物治疗（OMT）二级预防方案的患者未来的 CV 事件。
在 ACS 急性期开始 OMT 以及治疗和饮食教育计划，然后在 ACS 后 3 个月根据需要进行监测和调整。在 ACS 后 3 个月测量 hsCRP，并在此时间点评估动脉粥样硬化负担和危险因素的总体评估。根据 hsCRP 值将研究人群分为三分位，并随访 CV 事件。
共纳入 1202 例 hsCRP<15mg/L 的连续患者，其中 795 例平均随访 22 个月。在第 3 个月时，hsCRP 处于第二和第三分位的患者的 LDL-胆固醇、HbA1c、腰围、收缩压、代谢综合征、吸烟和动脉粥样硬化负担均高于处于第一分位的患者（p<0.001）。hsCRP 水平与 CV 总事件的复发（HR 1.29，CI 0.83-2.00）在单因素分析中无关。我们进一步检查了将 hsCRP 水平添加到Framingham 风险评估评分中的效果，发现 Framingham 风险评估评分的 C 统计量没有显著提高。
hsCRP 与 CV 危险因素相关，但不能独立预测接受 OMT 二级预防方案的 ACS 后患者的未来事件。
