Published online before print July 17, 2006, doi: 10.1161/CIRCULATIONAHA.106.628909
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(Circulation. 2006;114:281-288.)
© 2006 American Heart Association, Inc.
Coronary Heart Disease |
Clinical Relevance of C-Reactive Protein During Follow-Up of Patients With Acute Coronary Syndromes in the Aggrastat-to-Zocor Trial
From the TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, Mass (D.A.M., M.S.S., S.D.W., A.S., E.B.); Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, Dallas, Tex (J.A.d.L.); Duke Clinical Research Institute, Durham, NC (M.A.B., R.M.C.); and Children’s Hospital, Boston, Mass (N.R.).
Correspondence to Dr David A. Morrow, TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115. E-mail dmorrow{at}partners.org
Received March 23, 2006; revision received April 29, 2006; accepted May 2, 2006.
Background— Elevated levels of high-sensitivity C-reactive protein (hsCRP) are associated with higher risk of adverse outcomes in patients at risk for or with established coronary artery disease. Retrospective analyses suggest that this risk may be modified with statin therapy. However, a role for hsCRP in monitoring the success of therapy remains uncertain.
Methods and Results— We measured the serum concentration of hsCRP at 30 days (n=3813) and 4 months in patients with non–ST-elevation or ST-elevation acute coronary syndrome randomly assigned to an early intensive versus delayed conservative simvastatin strategy in the Aggrastat-to-Zocor Trial. Patients with hsCRP >3 mg/L at 30 days had significantly higher 2-year mortality rates than those with hsCRP 1 to 3 mg/L or hsCRP <1 mg/L (6.1% versus 3.7% versus 1.6%, P<0.0001). Results were similar with hsCRP measured at 4 months. After adjusting for age, gender, diabetes, smoking, cardiovascular history, index event, lipid levels, and randomly assigned treatment, patients with hsCRP >3 mg/L were at more than 3-fold higher risk of death (HR, 3.7; 95% CI, 1.9 to 7.2) compared with those with hsCRP <1 mg/L. "Average" levels of hsCRP (1 to 3 mg/L) were also associated with increased risk compared with those with hsCRP <1 mg/L (HR, 2.3; 95% CI, 1.2 to 4.6). Patients allocated to early intensive statin therapy were more likely to achieve hsCRP levels <1 mg/L at 30 days (P=0.028) and 4 months (P<0.0001).
Conclusions— Achieved levels of hsCRP at 30 days and 4 months after acute coronary syndrome are independently associated with long-term survival. Patients treated with more aggressive statin therapy are more likely to achieve lower levels of hsCRP.
CLINICAL PERSPECTIVE
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