Prognostic value of highly sensitive C-reactive protein and plaque morphology in coronary artery disease in China

Inflammation contributes to the initiation and progression of coronary atherosclerosis. A highly sensitive C-reactive protein (hs-CRP) can be used as a predictor of future coronary events in healthy populations and in patients with angina. However, the relationship between hs-CRP and coronary lesion characteristics as well as their associations with clinical outcomes in Chinese patients with coronary artery diseases has not been well described. This study aimed to investigate the prognostic value of coronary lesion characteristics and hs-CRP in Chinese patients with coronary artery disease. Coronary lesion characteristics were characterized by intravascular ultrasound. Serum hs-CRP and pro-matrix metalloproteinase-1 (ProMMP-1) concentrations were measured by sandwich enzyme-linked immunosorbent assay in 184 patients. Among these patients, 101 suffered from acute coronary syndrome (ACS) and 83 suffered from stable angina (SA). These patients were followed up for one year to monitor subsequent major adverse cardiac events (MACE). Patients with ACS exhibited an increased external elastic membrane cross-sectional area, plaque burden, lipid pool burden, and remodeling index compared with the patients with SA (P < 0.05). Rupture and vulnerable plaques were more frequently observed in patients with ACS than in patients with SA (40.59% vs. 1.20% and 42.57% vs. 3.61%, respectively; P < 0.001). Serum hs-CRP and proMMP-1 concentrations were higher in patients with ACS (18.17 [6.32, 22.10] mg/L vs. 3.75 [1.86, 4.32] mg/L, P < 0.001 and 1.56 [0.72, 1.82] ng/ml vs. 1.14 [0.75, 1.14] ng/ml, P = 0.012]. Strong associations were found between hs-CRP, proMMP-1 and plaque type. Univariate analysis found that ACS, Troponin I and hs-CRP were associated with MACE, while multivariate logistic regression found that only hs-CRP was independently associated with MACE for one year. An increase in hs-CRP is correlated with rupture and vulnerable plaques. hs-CRP but not plaque morphology is associated with poor prognosis in Chinese patients with coronary artery disease.