Serial CRP Results Predict Continued Risk Following Heart Attack

Serial measurement of high-sensitivity C-reactive protein (hsCRP) levels following acute coronary syndrome may help better identify patients at greater risk for recurrent cardiovascular events or death despite optimal medical therapy, according to a study published March 6 in JAMA Cardiology. These high-risk patients may benefit from more intensive treatment.

Data for this study came from secondary analysis of the Vascular Inflammation Suppression to Treat Acute Coronary Syndromes clinical trial that included 5,145 patients (treated at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America). The 4,257 included patients (73.8 percent male; mean age 60.3 years) were optimally medically treated with antiplatelet and cholesterol-lowering medications and had available baseline and longitudinal hsCRP levels measured at weeks 1, 2, 4, 8, and 16 after randomization.

The researchers found that both baseline and longitudinal hsCRP levels were independently associated with increased risk of a major adverse cardiac event (MACE), cardiovascular death, and all-cause death over 16 weeks of follow-up. Findings remained even after adjusting for drug treatment and baseline hsCRP. Each standard deviation increase in longitudinal hsCRP concentration was associated with a 15 percent increased risk of MACE, 25 percent increased risk of all-cause death, and 26 percent increased risk of cardiovascular death.

“Serial measurements of hsCRP during clinical follow-up after ACS may help to identify patients at higher risk for mortality and morbidity,” write the authors led by Preethi Mani, M.D., from the Cleveland Clinic in Ohio. “Further studies will be required to determine whether initial and serial hsCRP measurements can help guide the use of targeted antiinflammatory therapies after ACS to help further reduce residual cardiovascular risk in this vulnerable population.”

Takeaway: Patients with increasing inflammation markers following acute coronary syndrome have residual risk for cardiac events and death. Serial measurement of hsCRP may help to customize higher intensity treatment for these high-risk patients.