Shimizu Takashi, Suwa Satoru, Dohi Tomotaka, Wada Hideki, Miyauchi Katsumi, Shitara Jun, Endo Hirohisa, Doi Shinichiro, Ogita Manabu, Kasai Takatoshi, Okazaki Shinya, Isoda Kikuo, Daida Hiroyuki
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine.
Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital.
Int Heart J. 2019 Sep 27;60(5):1037-1042. doi: 10.1536/ihj.18-683. Epub 2019 Sep 4.
Although high-sensitivity C-reactive protein (hs-CRP) has been used to predict the risk of adverse cardiac events in patients with coronary artery disease (CAD) after percutaneous coronary interventions (PCIs), little is known about the association between hs-CRP and long-term outcomes in patients with preserved renal function.Here, we studied 1,153 patients with stable CAD and preserved renal function (estimated glomerular filtration rate: > 60 mL/minute/1.73 m) who underwent their first PCI between 2000 and 2011. Those with available data on preprocedural hs-CRP were included. Patients were assigned to tertiles according to preprocedural hs-CRP levels. The incidence of major adverse cardiac events (MACE), including all-cause death and nonfatal myocardial infarction, was evaluated. During a median follow-up period of 7.5 years, Kaplan-Meier curves showed ongoing divergence in the rates of MACE among the hs-CRP tertiles (hs-CRP < 0.05 mg/L, 12.1%; 0.05-0.17 mg/L, 12.1%; > 0.17 mg/L, 21.6%; log-rank P = 0.003). After adjusting for the established cardiovascular risk factors, hs-CRP levels were found to be associated with a higher incidence of MACE (hazard ratio [HR]: 3.65, 95% confidence interval [CI]: 1.77-7.07; P = 0.0008) and a higher rate of all-cause mortality (HR: 5.14, 95% CI: 2.38-10.30; P < 0.0001).In conclusion, this long-term registry showed that preprocedural hs-CRP measurement is clinically useful for long-term risk assessments in patients with stable CAD and preserved renal function.
尽管高敏C反应蛋白（hs-CRP）已被用于预测经皮冠状动脉介入治疗（PCI）后冠心病（CAD）患者发生不良心脏事件的风险，但关于hs-CRP与肾功能正常患者长期预后之间的关联却知之甚少。在此，我们研究了2000年至2011年间接受首次PCI的1153例稳定型CAD且肾功能正常（估计肾小球滤过率：>60 mL/分钟/1.73 m²）的患者。纳入术前hs-CRP数据可用的患者。根据术前hs-CRP水平将患者分为三分位数。评估主要不良心脏事件（MACE）的发生率，包括全因死亡和非致命性心肌梗死。在中位随访期7.5年期间，Kaplan-Meier曲线显示hs-CRP三分位数组之间MACE发生率持续存在差异（hs-CRP<0.05 mg/L，12.1%；0.05-0.17 mg/L，12.1%；>0.17 mg/L，21.6%；对数秩检验P=0.003）。在调整既定的心血管危险因素后，发现hs-CRP水平与较高的MACE发生率（风险比[HR]：3.65，95%置信区间[CI]：1.77-7.07；P=0.0008）和较高的全因死亡率（HR：5.14，95%CI：2.38-10.30；P<0.0001）相关。总之，这项长期注册研究表明，术前hs-CRP测量对于稳定型CAD且肾功能正常患者的长期风险评估具有临床实用性。
