Role of Pre-procedural C-reactive Protein Level in the Prediction of Major Adverse Cardiac Events in Patients Undergoing
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Role of Pre-procedural C-reactive Protein Level in the Prediction of Major Adverse Cardiac Events in Patients Undergoing Percutaneous Coronary Intervention: a Meta-analysis of Longitudinal Studies Singh-baniya Bibek,1 Yong Xie,2,4 Jia-jia Gao,2,4 Zhi Wang,3 Jing-feng Wang,2,4,5 and Deng-feng Geng2,4,5
Abstract—Numerous studies have reported the relation between pre-procedural C-reactive protein (CRP) levels and the risk of major adverse cardiac events (MACEs) in patients undergoing percutaneous coronary intervention (PCI). However, the results across the studies were inconsistent. The aim of this study was to evaluate the predictive effect of pre-procedural CRP levels and the risk of MACEs in patients undergoing PCI. Longitudinal studies on the association between pre-procedural CRP levels and MACEs were identified by electronic and manual searches. Summary risk ratios (RRs) and 95 % confidence intervals (CI) were calculated employing an inverse variance random-effects model irrespective of between-study heterogeneity. Thirty-three studies involving 34,367 patients with 4119 MACEs were included in this study. High CRP level was associated with increased incidences of MACEs, all-cause death, myocardial infarction, coronary revascularization, and clinical restenosis, with pooled RRs of 1.97 (95 % CI, 1.65, 2.35), 2.88 (95 % CI, 2.15, 3.86), 1.81 (95 % CI, 1.48, 2.21), 1.31 (95 % CI, 1.11, 1.56), and 1.45 (95 % CI, 1.07, 1.96), respectively. Dose-response analysis showed that every 1 mg/L increment in pre-procedural serum CRP level was associated with a significant 12 % increase in the risk of MACEs. In spite of heterogeneity across the included studies, this meta-analysis suggests that pre-procedural serum CRP level is a valuable predictor of MACEs in patients undergoing PCI. KEY WORDS: pre-procedural CRP level; major adverse cardiac events; percutaneous coronary intervention; coronary artery disease.
INTRODUCTION Singh-baniya Bibek, Yong Xie, and Jia-jia Gao contributed equally to this work.
Inflammation plays a major role in the pathogenesis of atherosclerosis and its complications [1]. In recent years, increasing data have demonstrated a clear relationship between elevated inflammatory biomarkers and the risk of future atherothrombotic events in multiple clinical settings [2]. Creactive protein (CRP), an easily measurable acute phase reactant synthesized by hepatocytes in response to proinflammatory cytokines [3], is recognized as an important marker of vascular wall inflammation and as a strong predictor of major adverse cardiac events (MACEs). CRP levels have been associated with an increased risk of subsequent cardiovascular events in patients with or without evidence of
1
Department of Cardiology, Shahid Gangalal National Heart Center, Kathmandu, Nepal 2 Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No. 107 West Yanjiang Road, Guangzhou, 510120, China 3 Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Guangzhou, 510120, China 4 Guangdong Province Key Laborato
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