Vnitr Lek 2013, 59(12):1057-1064

Indicators of inflammation in patients with coronary atherosclerosis - role of usCRP in diagnosis and disease progression prediction

M. Samoš1,*, R. Pullmann2, S. Funiak1, M. Stančík1, M. Mokáň1
1 I. interná klinika Jesseniovej lekárskej fakulty UK a UN Martin, Slovenská republika, prednosta prof. MUDr. Marián Mokáň, DrSc., FRCP Edin.
2 Ústav klinickej biochémie Jesseniovej lekárskej fakulty UK a UN Martin, Slovenská republika, prednosta prof. MUDr. Dušan Dobrota, CSc.

Atherosclerosis is being nowadays defined as chronic subclinical inflammatory disease. Recently published clinical and laboratory studies have shown that subclinical inflammation represents main role in initiation of creation, in progress and destabilization of atherosclerotic plaque. Screening including traditional cardiovascular risk factors fails in identification in more than 50% of individuals with later development of acute coronary syndrome. According to above mentioned reason indicators are being searched for, which would be usable to monitor the activity of atherosclerotic process. According to role of subclinical inflammatory process in pathogenesis of atherosclerosis, the determination of C-reactive protein using ultrasensitive method is being showed as perspective marker. Ultrasensitive C-reactive protein represents a strong, independent predictor of future cardiovascular events in apparently healthy individuals and has also prognostic utility in patients with acute coronary syndromes. Predictive capacity of C-reactive protein determination is independent of traditional risk factors and offers prognostic advantage as opposed to determination of lipids alone. The paper provides a review of currently available knowledge of possibilities for utilization of C-reactive protein laboratory assessment, as the main representative of acute phase proteins, in monitoring of creation and severity of coronary atherosclerosis, in possibilities of the disease prognosis determination and prediction of its acute complications, and also in prediction of prognosis in patient with already existing acute complication.

Keywords: ultrasensitive C-reactive protein; coronary atherosclerosis; myocardial infarction

Received: March 21, 2013; Accepted: July 30, 2013; Published: December 1, 2013  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Samoš M, Pullmann R, Funiak S, Stančík M, Mokáň M. Indicators of inflammation in patients with coronary atherosclerosis - role of usCRP in diagnosis and disease progression prediction. Vnitr Lek. 2013;59(12):1057-1064.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Ross R. Atherosclerosis an inflammatory disease. N Engl J Med 1999; 340: 115-126. Go to original source... Go to PubMed...
    2. Hansson GK, Berne GP. Atherosclerosis and the immune system. Acta Paediatr Suppl 2004; 93: 63-69. Go to original source... Go to PubMed...
    3. Libby P. Inflammation in atherosclerosis. Nature 2002; 420: 868-874. Go to original source... Go to PubMed...
    4. Davies MJ. Stability and instability: two faces of coronary atherosclerosis. The Paul Dudley White Lecture 1995. Circulation 1996; 94: 2013-2020. Go to original source... Go to PubMed...
    5. Dollery CM, Libby P. Atherosclerosis and proteinase activation. Cardiovasc Res 2006; 69: 625-635. Go to original source... Go to PubMed...
    6. Dvořáková A, Poledne R. Ultrasenzitivně měřený C-reaktivní protein - nový parametr kardiovaskulárního rizika. Vnitř Lék 2004; 50: 852-857. Go to PubMed...
    7. Ošťádal P. C-reaktivní protein - molekula, která změnila kardiologii. Editorial k článku Dvořáková et al Ultrasenzitivně měřený C-reaktivní protein - nový parametr kardiovaskulárního rizika. Vnitř Lék 2004; 50: 809-811. Go to PubMed...
    8. Pullmann R, Pavlovič M. Laboratórne nálezy a ich klinická interpretácia. Bratislava: Raabe 2007.
    9. Meško D, Pullmann R, Nosáľová G. Vademékum klinickej biochémie. Martin: Osveta 1998.
    10. Špirková Z, Daňová K, Pecháň I et al. Kardiomarkery. Bratislava: Phonec agency 2003.
    11. Ridker PM, Hennekens CH, Buring JE et al. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. N Engl J Med 2000; 342: 836-843. Go to original source... Go to PubMed...
    12. Rifai N, Tracy RP, Ridker PM. Clinical efficacy of an automated high-sensitivity C-reactive protein assay. Clin Chem 1999; 45: 2136-2141. Go to original source...
    13. Ess SM, Szucs TD. Medical-economical aspects of high sensitivity C-reactive protein assay for the prediction of coronary heart dis-ease. An analysis in Germany and Italy. Ital Heart J 2001; 2: 181-188. Go to original source... Go to PubMed...
    14. Ridker PM, Morrow DA. C-reactive protein, inflammation, and coronary risk. Cardiol Clin 2003; 21: 315-325. Go to original source... Go to PubMed...
    15. Zakynthinos E, Pappa N. Inflammatory biomarkers in coronary artery disease. J Cardiol 2009; 53: 317-333. Go to original source... Go to PubMed...
    16. Ridker PM, Macfadyen JG, Nordestgaard BG et al. Rosuvastatin for primary prevention among individuals with elevated high-sensitivity C-reactive protein and 5% to 10% and 10% to 20% 10-year risk. Implications of the Justification for Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin (JUPITER) trial for "intermediate risk". Circ Cardiovasc Qual Outcomes 2010; 3: 447-452. Go to original source... Go to PubMed...
    17. Schnell-Inderst P, Schwarzer R, Göhler A at al. Prognostic value, clinical effectiveness, and cost-effectiveness of high-sensitivity C-reactive protein as a marker for major cardiac events in asymptomatic individuals: a health technology assessment report. Int J Technol Assess Health Care 2010; 26: 30-39. Go to original source... Go to PubMed...
    18. Choudhry NK, Patrick AR, Glynn RJ et al. The cost-effectiveness of C-reactive protein testing and rosuvastatin treatment for patients with normal cholesterol levels. J Am Coll Cardiol 2011; 57: 784-791. Go to original source... Go to PubMed...
    19. Wijns W, Kohl P, Danchin N et al. Guidelines on myocardial revascularization. Eur Heart J 2010; 31: 2501-2555. Go to original source... Go to PubMed...
    20. Perk J, De Backer G, Gohlke H et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012; 33: 1635-1701. Go to original source... Go to PubMed...
    21. Stone JA, Arthur HM. Canadian Guidelines for cardiac rehabilitation and cardiovascular disease prevention, second edition, 2004: executive summary. Can J Cardiol 2005; 21 (Suppl D): 3D-19D. Go to PubMed...
    22. Veselka J, Procházková S, Duchonová R et al. Relationship of C-reactive protein to presence and severity of coronary atherosclerosis in patients with stable angina pectoris or a pathological exercise test. Coron Artery Dis 2002; 3: 151-154. Go to original source... Go to PubMed...
    23. Zairis MN, Papadaki OA, Manousakis SJ et al. C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina. Atherosclerosis 2002; 164: 355-359. Go to original source... Go to PubMed...
    24. Noto D, Cottone S, Baldassare Cefalù A et al. Interleukin 6 plasma levels predict with high sensitivity and specificity coronary stenosis detected by coronary angiography. Thromb Haemost 2007; 98: 1362-1367. Go to original source... Go to PubMed...
    25. Piechota W, Piechota W. Correlation of high-sensitivity CRP concentration with the extent of coronary atherosclerosis in men with symptoms of ischemic heart disease. Pol Merkur Lekarski 2005; 18: 511-515. Go to PubMed...
    26. Liang KW, Sheu WH, Lee WL et al. Coronary artery disease progression is associated with C-reactive protein and conventional risk factors but not soluble CD40 ligand. Can J Cardiol 2006; 22: 691-696. Go to original source... Go to PubMed...
    27. Sukhija R, Fahdi I, Garza L et al. Inflammatory markers, angiographic severity of coronary artery disease, and patient outcome. Am J Cardiol 2007; 99: 879-884. Go to original source... Go to PubMed...
    28. Ulucay A, Demirbag R, Yilmaz R et al. The relationship between plasma C-reactive protein levels and presence and severity of coronary stenosis in patients with stable angina. Angiology 2007; 58: 657-662. Go to original source... Go to PubMed...
    29. Paniugova EV, Aleksandrova EN, Nasonov EL et al. Atherosclerotic lesion of the vessels in patients with stable coronary artery disease: relations with concentration of C-reactive protein. Kardiologiia 2009; 49: 40-45.
    30. Auer J, Rammer M, Berent R et al. Relation of C-reactive protein levels to presence, extent, and severity of angiographic coronary artery disease. Indian Heart J 2002; 54: 284-288.
    31. Kazanis K, Dalamaga M, Nounopoulos C et al. Ischemia modified albumin, high-sensitivity C-reactive protein and natriuretic peptide in patients with coronary atherosclerosis. Clin Chim Acta 2009; 408: 65-69. Go to original source... Go to PubMed...
    32. Momiyama Y, Ohmori R, Fayad ZA et al. Associations between plasma C-reactive protein levels and the severities of coronary and aortic atherosclerosis. J Atheroscler Thromb 2010; 17: 460-467. Go to original source... Go to PubMed...
    33. Gotsman I, Stabholz A, Planer D et al. Serum cytokine tumor necrosis factor-alpha and interleukin-6 associated with the severity of coronary artery disease: indicators of an active inflammatory burden? Isr Med Assoc J 2008; 10: 494-498. Go to PubMed...
    34. Mori T, Sasaki J, Kawaguchi H et al. Serum glycoproteins and severity of coronary atherosclerosis. Am Heart J 2010; 129: 234-238. Go to original source... Go to PubMed...
    35. Samoš M, Funiak S, Karaffová N et al. Indikátory zápalu u koronarografovaných pacientov. Ateroskleróza 2012; 16: 279-284.
    36. Haverkate F, Thompson SG, Pyke SD et al. Production of C-reactive protein and risk of coronary events in stable and unstable angina. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. Lancet 1997; 349: 462-466. Go to original source... Go to PubMed...
    37. Ridker PM, Cushman M, Stampfer MJ et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973-979. Go to original source... Go to PubMed...
    38. Ridker PM, Rifai N, Pfeffer MA et al. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events (CARE) Investigators. Circulation 1998; 98: 839-844. Go to original source... Go to PubMed...
    39. Doggen CJ, Berckmans RJ, Sturk A et al. C-reactive protein, cardiovascular risk factors and the association with myocardial infarction in men. J Intern Med 2008; 248: 406-414. Go to original source... Go to PubMed...
    40. Speidl WS, Graf S, Hornykewycz S et al. High-sensitivity C-reactive protein in the prediction of coronary events in patients with premature coronary artery disease. Am Heart J 2002; 144: 449-455. Go to original source... Go to PubMed...
    41. Roubille F, Cayla G, Picot MC et al. C-reactive protein (CRP) after revascularized STEMI: is CRP a prognostic factor? Rev Med Interne 2008; 29: 868-874. Go to original source... Go to PubMed...
    42. Fisman EZ, Benderly M, Esper RJ et al. Interleukin-6 and the risk of future cardiovascular events in patients with angina pectoris and/or healed myocardial infarction. Am J Cardiol 2006; 98: 14-18. Go to original source... Go to PubMed...
    43. Karpiński L, Płaksej R, Kosmala W et al. Serum levels of interleukin-6, interleukin-10 and C-reactive protein in relation to left ventricular function in patients with myocardial infarction treated with primary angioplasty. Kardiol Pol 2008; 66: 1279-1285. Go to original source... Go to PubMed...
    44. Akkus MN, Polat G, Yurtdas M et al. Admission levels of C-reactive protein and plasminogen activator inhibitor-1 in patients with acute myocardial infarction with and without cardiogenic shock or heart failure on admission. Int Heart J 2009; 50: 33-45. Go to original source... Go to PubMed...
    45. Kohno T, Anzai T, Naito K et al. Impact of serum C-reactive protein elevation on the left ventricular spherical change and the development of mitral regurgitation after anterior acute myocardial infarction. Cardiology 2007; 107: 386-394. Go to original source... Go to PubMed...
    46. Anzai T, Yoshikawa T, Shiraki H et al. C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction. Circulation 1997; 96: 778-784. Go to original source... Go to PubMed...
    47. Celik T, Iyisoy A, Kursaklioglu H et al. The impact of admission C-reactive protein levels on the development of poor myocardial perfusion after primary percutaneous intervention in patients with acute myocardial infarction. Coron Artery Dis 2005; 16: 293-299. Go to original source... Go to PubMed...
    48. Gedikli O, Orem C, Baykan M et al. Association between serum C-reactive protein elevation and atrial fibrillation after first anterior myocardial infarction. Clin Cardiol 2008; 31: 482-487. Go to original source... Go to PubMed...
    49. Kaneko H, Anzai T, Naito K et al. Role of ischemic preconditioning and inflammatory response in the development of malignant ventricular arrhythmias after reperfused ST-elevation myocardial infarction. J Card Fail 2009; 15: 775-781. Go to original source... Go to PubMed...
    50. Tanaka A, Shimada K, Sato T et al. Multiple plaque rupture and C-reactive protein in acute myocardial infarction. J Am Coll Cardiol 2005; 45: 1594-1599. Go to original source... Go to PubMed...
    51. Kuch B, von Scheidt W, Kling B et al. Differential impact of admission C-reactive protein levels on 28-day mortality risk in patients with ST-elevation versus non-ST-elevation myocardial infarction (from the Monitoring Trends and Determinants on Cardiovascular Diseases [MONICA]/Cooperative Health Research in the Region of Augsburg [KORA] Augsburg Myocardial Infarction Registry). Am J Cardiol 2008; 102: 1125-1130. Go to original source... Go to PubMed...
    52. Möckel M, Heller G Jr, Müller C et al. C-reactive protein as an independent marker of prognosis in acute coronary syndrome: comparison with troponin T. Z Kardiol 2000; 89: 658-666. Go to original source...
    53. Berton G, Cordiano R, Palmieri R et al. Comparison of C-reactive protein and albumin excretion as prognostic markers for 10-year mortality after myocardial infarction. Clin Cardiol 2010; 33: 508-515. Go to original source... Go to PubMed...
    54. Foussas SG, Zairis MN, Makrygiannis SS et al. The significance of circulating levels of both cardiac troponin I and high-sensitivity C-reactive protein for the prediction of intravenous thrombolysis outcome in patients with ST-segment elevation myocardial infarction. Heart 2007; 93: 952-956. Go to original source... Go to PubMed...
    55. Kuklinska AM, Sobkowicz B, Mroczko B et al. Prognostic significance of the admission plasma B-type natriuretic peptide measurement in patients with first ST-elevation myocardial infarction in comparison with C-reactive protein and TIMI risk score. Clin Chim Acta 2007; 382: 106-11. Go to original source... Go to PubMed...
    56. Brodov Y, Behar S, Goldenberg I et al. Usefulness of combining serum uric acid and C-reactive protein for risk stratification of patients with coronary artery disease (Bezafibrate Infarction Prevention [BIP] study). Am J Cardiol 2009; 104: 194-198. Go to original source... Go to PubMed...
    57. Raposeiras-Roubin S, Barreiro Paradal C, Rodino Janeiro B et al. High-sensitivity C-reactive protein is a predictor of in-hospital cardiac events in acute myocardial infarction independently of GRACE risk score. Angiology 2012; 63: 30-34. Go to original source... Go to PubMed...
    58. Bazzino O, Fuselli JJ, Botto F et al. Relative value of N-terminal probrain natriuretic peptide, TIMI risk score, ACC/AHA prognostic classification and other risk markers in patients with non-ST-elevation acute coronary syndromes. Eur Heart J 2004; 25: 859-866. Go to original source... Go to PubMed...
    59. Roubille F, Samri A, Cornillet L et al. Routinely-feasible multiple biomarkers score to predict prognosis after revascularized STEMI. Eur J Intern Med 2010; 21: 131-136. Go to original source... Go to PubMed...
    60. Beijk MA, Koch KT, Tijssen JG et al. A retrospective analysis of consecutive patients undergoing nonurgent percutaneous coronary intervention comparing bare metal stents with drug-eluting stents using the National Institute for Clinical Excellence criteria. Coron Artery Dis 2011; 22: 32-39. Go to original source... Go to PubMed...
    61. Razzouk L, Muntner P, Bansilal S et al. C-reactive protein predicts long-term mortality independently of low-density lipoprotein cholesterol in patients undergoing percutaneous coronary intervention. Am Heart J 2009; 158: 277-283. Go to original source... Go to PubMed...
    62. Choi DH, Park KW, Yang HM et al. Renal dysfunction and high levels of hsCRP are additively associated with hard endpoints after percutaneous coronary intervention with drug eluting stents. Int J Cardiol 2011; 149: 174-181. Go to original source... Go to PubMed...
    63. Fournier JA, Delgado-Pecellín C, Cayuela A et al. The high-sensitivity C-reactive protein level one month after bare-metal coronary stenting may predict late adverse events. Rev Esp Cardiol 2008; 61: 313-316. Go to original source...
    64. Iijima R, Byrne RA, Ndrepepa G et al. Pre-procedural C-reactive protein levels and clinical outcomes after percutaneous coronary interventions with and without abciximab: pooled analysis of four ISAR trials. Heart 2009; 95: 107-112. Go to original source... Go to PubMed...
    65. Gach O, Legrand V, Biessaux Y et al. Long-term prognostic significance of high-sensitivity C-reactive protein before and after coronary angioplasty in patients with stable angina pectoris. Am J Cardiol 2007; 99: 31-35. Go to original source... Go to PubMed...
    66. Karha J, Bavry AA, Rajagopal V et al. Relation of C-reactive protein level and long-term risk of death or myocardial infarction following percutaneous coronary intervention with a sirolimus-eluting stent. Am J Cardiol 2006; 98: 616-618. Go to original source... Go to PubMed...
    67. Ishii H, Toriyama T, Aoyama T et al. Prognostic values of C-reactive protein levels on clinical outcome after implantation of sirolimus-eluting stents in patients on hemodialysis. Circ Cardiovasc Interv 2009; 2: 513-518. Go to original source... Go to PubMed...
    68. Hoshida S, Nishino M, Takeda T et al. A persistent increase in C-reactive protein is a risk factor for restenosis in patients with stable angina who are not receiving statins. Atherosclerosis 2004; 173: 285-290. Go to original source... Go to PubMed...
    69. Grander W, Dichtl W, Prokop W et al. C-reactive protein plasma levels but not factor VII activity predict clinical outcome in patients undergoing elective coronary intervention. Clin Cardiol 2004; 27: 211-216. Go to original source... Go to PubMed...
    70. Saleh N, Tornvall P. Serum C-reactive protein response to percutaneous coronary intervention in patients with unstable or stable angina pectoris is associated with the risk of clinical restenosis. Atherosclerosis 2007; 195: 374-378. Go to original source... Go to PubMed...
    71. Jeong WK, Jeong MH, Kim KH et al. An elevated value of C-reactive protein is the only predictive factor of restenosis after percutaneous coronary intervention. Korean J Intern Med 2003; 18: 154-160. Go to original source... Go to PubMed...
    72. Žurakowski A, Wojakowski W, Dzielski T et al. Plasma levels of C-reactive protein and interleukin-10 predict late coronary in-stent restenosis 6 months after elective stenting. Kardiol Pol 2009; 15: 623-630.
    73. Vaněk I et al. Kardiovaskulární chirurgie. Praha: Karolinum 2003.
    74. Biancari F, Lahtinen J, Lepojärvi S et al. Preoperative C-reactive protein and outcome after coronary artery bypass surgery. Ann Thorac Surg 2003; 76: 2007-2012. Go to original source... Go to PubMed...
    75. Kangasniemi OP, Biancari F, Luukkonen J et al. Preoperative C-reactive protein is predictive of long-term outcome after coronary artery bypass surgery. Eur J Cardiothorac Surg 2006; 29: 983-985. Go to original source... Go to PubMed...
    76. Balciunas M, Bagdonaite L, Samalavicius R et al. Pre-operative high sensitive C-reactive protein predicts cardiovascular events after coronary artery bypass grafting surgery: a prospective observational study. Ann Card Anaesth 2009; 12: 127-132. Go to original source... Go to PubMed...
    77. Perry TE, Muehlschlegel JD, Liu KY et al. CABG Genomics Investigators: Preoperative C-reactive protein predicts long-term mortality and hospital length of stay after primary, nonemergent coronary artery bypass grafting. Anesthesiology 2010; 112: 607-613. Go to original source... Go to PubMed...
    78. Ishida K, Kimura F, Imamaki M et al. Relation of inflammatory cytokines to atrial fibrillation after off-pump coronary artery bypass grafting. Eur J Cardiothorac Surg 2006; 29: 501-505. Go to original source... Go to PubMed...
    79. Kaireviciute D, Blann AD, Balakrishnan B et al. Characterisation and validity of inflammatory biomarkers in the prediction of post-operative atrial fibrillation in coronary artery disease patients. Thromb Haemost 2010; 104: 122-127. Go to original source... Go to PubMed...
    80. Ziabakhsh-Tabari S. Can perioperative C-reactive protein and interleukin-6 levels predict atrial fibrillation after coronary artery bypass surgery? Saudi Med J 2008; 29: 1429-1431. Go to PubMed...

    Return to the content


    Vnitřní lékařství

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.