Ndrepepa Gjin, Braun Siegmund, Tada Tomohisa, King Lamin, Cassese Salvatore, Fusaro Massimiliano, Keta Dritan, Kastrati Adnan, Schmidt Roland
German Heart Centre, Technical University, Munich, Germany.
Indian J Med Res. 2014 Sep;140(3):392-400.
BACKGROUND & OBJECTIVES: The comparative prognostic value of C-reactive protein (CRP) and fibrinogen for cardiovascular events has been inconclusively investigated. t0 his study was carried out to compare the prognostic value of CRP versus fibrinogen in patients with coronary artery disease (CAD).
The study included 13,100 patients with coronary angiography-confirmed CAD. Plasma CRP and fibrinogen levels were measured before angiography in all patients. The levels of CRP>3 mg/l and fibrinogen>350 mg/dl were considered as elevated. The primary outcome was 1-year all-cause mortality.
Patients were divided into four groups: patients with CRP≤3 mg/l and fibrinogen ≤350 mg/dl (n=4206); patients with CRP≤3 mg/l and fibrinogen >350 mg/dl (n=3132); patients with CRP>3 mg/l and fibrinogen ≤ 350 mg/dl (n=1273) and CRP >3 mg/l and patients with fibrinogen >350 mg/dl (n=4489). There were 634 deaths: 75 deaths in patients with CRP ≤3 mg/l and fibrinogen ≤350 mg/dl, 91 deaths in patients with CRP ≤3 mg/l and fibrinogen >350 mg/dl, 87 deaths in patients with CRP >3 mg/l and fibrinogen ≤350 mg/dl and 381 deaths in patients with CRP >3 mg/l and fibrinogen >350 mg/dl (Kaplan-Meier estimates of all-cause mortality, 1.8, 3.0, 7.0 and 8.7 %, log-rank test P<0.001). The multivariate analysis showed that CRP [adjusted hazard ratio (HR)=1.31, 95% confidence interval (CI) 1.18-1.45, for each standard deviation increase in the logarithmic scale] but not fibrinogen [adjusted HR=0.99 (0.90-1.09), for each standard deviation increase in the logarithmic scale] was an independent correlate of mortality.
INTERPRETATION & CONCLUSIONS: The findings indicated that in patients with CAD, CRP was a better predictor of mortality than fibrinogen and offered prognostic information beyond that provided by the conventional cardiovascular risk factors.
C反应蛋白（CRP）和纤维蛋白原对心血管事件的比较预后价值尚未得到定论。本研究旨在比较CRP与纤维蛋白原在冠状动脉疾病（CAD）患者中的预后价值。
该研究纳入了13100例经冠状动脉造影确诊的CAD患者。所有患者在造影前均检测血浆CRP和纤维蛋白原水平。CRP>3mg/l和纤维蛋白原>350mg/dl被视为升高。主要结局为1年全因死亡率。
患者分为四组：CRP≤3mg/l且纤维蛋白原≤350mg/dl的患者（n=4206）；CRP≤3mg/l且纤维蛋白原>350mg/dl的患者（n=3132）；CRP>3mg/l且纤维蛋白原≤350mg/dl的患者（n=1273）以及CRP>3mg/l且纤维蛋白原>350mg/dl的患者（n=4489）。共有634例死亡：CRP≤3mg/l且纤维蛋白原≤350mg/dl的患者中有75例死亡，CRP≤3mg/l且纤维蛋白原>350mg/dl的患者中有91例死亡，CRP>3mg/l且纤维蛋白原≤350mg/dl的患者中有87例死亡，CRP>3mg/l且纤维蛋白原>350mg/dl的患者中有381例死亡（全因死亡率的Kaplan-Meier估计值分别为1.8%、3.0%、7.0%和8.7%，对数秩检验P<0.001）。多变量分析显示，CRP[调整后风险比（HR）=1.31，95%置信区间（CI）1.18-1.45，对数尺度每增加一个标准差]而非纤维蛋白原[调整后HR=0.99（0.90-1.09），对数尺度每增加一个标准差]是死亡率的独立相关因素。
研究结果表明，在CAD患者中，CRP比纤维蛋白原是更好的死亡率预测指标，且能提供超越传统心血管危险因素的预后信息。
