(Circulation. 1999;99:855-860.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Elevated Levels of C-Reactive Protein at Discharge in Patients With Unstable Angina Predict Recurrent Instability
From the Institute of Cardiology and Institute of Microbiology Catholic University of the Sacred Heart (R.L.G., G.F.), Rome, Italy.
Correspondence to Luigi M. Biasucci, Istituto di Cardiologia, Universitá Cattolica del S Cuore, Largo Francesco Vito 1, 00168 Roma, Italy. E-mail biasucci{at}pelagus.it
Background—In a group of patients admitted for unstable angina, we investigated whether C-reactive protein (CRP) plasma levels remain elevated at discharge and whether persistent elevation is associated with recurrence of instability.
Methods and Results—We measured plasma levels of CRP, serum
amyloid A protein (SAA), fibrinogen, total cholesterol, and
Helicobacter pylori and
Chlamydia pneumoniae antibody titers in
53 patients admitted to our coronary care unit for Braunwald
class IIIB unstable angina. Blood samples were taken on admission, at
discharge, and after 3 months. Patients were followed for 1 year. At
discharge, CRP was elevated (>3 mg/L) in 49% of patients; of these,
42% had elevated levels on admission and at 3 months. Only 15% of
patients with discharge levels of CRP <3 mg/L but 69% of those with
elevated CRP (P<0.001) were readmitted because of
recurrence of instability or new myocardial infarction. New
phases of instability occurred in 13% of patients in the lower tertile
of CRP (
2.5 mg/L), in 42% of those in the intermediate tertile (2.6
to 8.6 mg/L), and in 67% of those in the upper tertile (
8.7 mg/L,
P<0.001). The prognostic value of SAA was similar to
that of CRP; that of fibrinogen was not significant.
Chlamydia pneumoniae but not
Helicobacter pylori antibody titers
significantly correlated with CRP plasma levels.
Conclusions—In unstable angina, CRP may remain elevated for at
3 months after the waning of symptoms and is associated with
recurrent instability. Elevation of acute-phase reactants in unstable
angina could represent a hallmark of subclinical persistent
instability or of susceptibility to recurrent instability and, at least
in some patients, could be related to chronic Chlamydia
pneumoniae infection.
Key Words: angina • prognosis • Chlamydia pneumoniae
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J. F. Keaney Jr. and J. A. Vita The Value of Inflammation for Predicting Unstable Angina N. Engl. J. Med., July 4, 2002; 347(1): 55 - 57. [Full Text] [PDF]
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D. L. Bhatt and E. J. Topol Need to Test the Arterial Inflammation Hypothesis Circulation, July 2, 2002; 106(1): 136 - 140. [Full Text] [PDF]
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E. Ronner, E. Boersma, G.-J. Laarman, G. A. Somsen, R. A. Harrington, J. W. Deckers, E. J. Topol, R. M. Califf, and M. L. Simoons Early angioplasty in acute coronary syndromes without persistent st-segment elevation improves outcome but increases the need for six-month repeat revascularization: An analysis of the pursuit trial J. Am. Coll. Cardiol., June 19, 2002; 39(12): 1924 - 1929. [Abstract] [Full Text] [PDF]
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R.J. de Winter, G.S. Heyde, K.T. Koch, J. Fischer, J.P. van Straalen, M. Bax, C.E. Schotborgh, K.J. Mulder, G.T. Sanders, J.J. Piek, et al. The prognostic value of pre-procedural plasma C-reactive protein in patients undergoing elective coronary angioplasty Eur. Heart J., June 2, 2002; 23(12): 960 - 966. [Abstract] [Full Text] [PDF]
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P. Libby, P. M. Ridker, and A. Maseri Inflammation and Atherosclerosis Circulation, March 5, 2002; 105(9): 1135 - 1143. [Abstract] [Full Text] [PDF]
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N T Mulvihill and J B Foley Inflammation in acute coronary syndromes Heart, March 1, 2002; 87(3): 201 - 204. [Abstract] [Full Text] [PDF]
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G. G.L. Biondi-Zoccai, A. Abbate, L. M. Biasucci, P. R. Kalra, R. Sharma, A. D. Struthers, J. A. de Lemos, D. A. Morrow, and E. Braunwald B-Type Natriuretic Peptide and Acute Coronary Syndromes N. Engl. J. Med., February 7, 2002; 346(6): 453 - 455. [Full Text] [PDF]
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M. S. Elkind, J. Cheng, B. Boden-Albala, T. Rundek, J. Thomas, H. Chen, L. E. Rabbani, R. L. Sacco, and A. G. Thrift Tumor Necrosis Factor Receptor Levels Are Associated With Carotid Atherosclerosis * Editorial Comment Stroke, January 1, 2002; 33(1): 31 - 38. [Abstract] [Full Text] [PDF]
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G. J. Blake and P. M. Ridker Novel Clinical Markers of Vascular Wall Inflammation Circ. Res., October 26, 2001; 89(9): 763 - 771. [Abstract] [Full Text] [PDF]
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A. Galante, A. Pietroiusti, M. Vellini, P. Piccolo, G. Possati, M. De Bonis, R. L. Grillo, C. Fontana, and C. Favalli C-reactive protein is increased in patients with degenerative aortic valvular stenosis J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1078 - 1082. [Abstract] [Full Text] [PDF]
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S. Blankenberg, H. J. Rupprecht, C. Bickel, D. Peetz, G. Hafner, L. Tiret, and J. Meyer Circulating Cell Adhesion Molecules and Death in Patients With Coronary Artery Disease Circulation, September 18, 2001; 104(12): 1336 - 1342. [Abstract] [Full Text] [PDF]
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D.J. Brull, H.E. Montgomery, J. Sanders, S. Dhamrait, L. Luong, A. Rumley, G.D.O. Lowe, and S.E. Humphries Interleukin-6 Gene -174G>C and -572G>C Promoter Polymorphisms Are Strong Predictors of Plasma Interleukin-6 Levels After Coronary Artery Bypass Surgery Arterioscler Thromb Vasc Biol, September 1, 2001; 21(9): 1458 - 1463. [Abstract] [Full Text] [PDF]
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P. Bogaty, P. Poirier, S. Simard, L. Boyer, S. Solymoss, and G. R. Dagenais Biological Profiles in Subjects With Recurrent Acute Coronary Events Compared With Subjects With Long-Standing Stable Angina Circulation, June 26, 2001; 103(25): 3062 - 3068. [Abstract] [Full Text] [PDF]
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N T Mulvihill, J B Foley, R T Murphy, R Curtin, P A Crean, and M Walsh Risk stratification in unstable angina and non-Q wave myocardial infarction using soluble cell adhesion molecules Heart, June 1, 2001; 85(6): 623 - 627. [Abstract] [Full Text]
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V. Pasceri, J. Chang, J. T. Willerson, and E. T. H. Yeh Modulation of C-Reactive Protein-Mediated Monocyte Chemoattractant Protein-1 Induction in Human Endothelial Cells by Anti-Atherosclerosis Drugs Circulation, May 29, 2001; 103(21): 2531 - 2534. [Abstract] [Full Text] [PDF]
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G. Liuzzo, D. J. Angiolillo, A. Buffon, V. Rizzello, C. Colizzi, F. Ginnetti, L. M. Biasucci, and A. Maseri Enhanced Response of Blood Monocytes to In Vitro Lipopolysaccharide-Challenge in Patients With Recurrent Unstable Angina Circulation, May 8, 2001; 103(18): 2236 - 2241. [Abstract] [Full Text] [PDF]
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P. M. Ridker High-Sensitivity C-Reactive Protein : Potential Adjunct for Global Risk Assessment in the Primary Prevention of Cardiovascular Disease Circulation, April 3, 2001; 103(13): 1813 - 1818. [Abstract] [Full Text] [PDF]
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M. Di Napoli, F. Papa, and V. Bocola C-Reactive Protein in Ischemic Stroke : An Independent Prognostic Factor Stroke, April 1, 2001; 32(4): 917 - 924. [Abstract] [Full Text] [PDF]
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G.J. Blake and P.M. Ridker High sensitivity C-reactive protein for predicting cardiovascular disease: an inflammatory hypothesis Eur. Heart J., March 1, 2001; 22(5): 349 - 352. [PDF]
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N. Rifai and P. M. Ridker High-Sensitivity C-Reactive Protein: A Novel and Promising Marker of Coronary Heart Disease Clin. Chem., March 1, 2001; 47(3): 403 - 411. [Abstract] [Full Text] [PDF]
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W. L. Roberts, L. Moulton, T. C. Law, G. Farrow, M. Cooper-Anderson, J. Savory, and N. Rifai Evaluation of Nine Automated High-Sensitivity C-Reactive Protein Methods: Implications for Clinical and Epidemiological Applications. Part 2 Clin. Chem., March 1, 2001; 47(3): 418 - 425. [Abstract] [Full Text] [PDF]
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U. Stenestrand, L. Wallentin, and for the Swedish Register of Cardiac Intensive Care Early Statin Treatment Following Acute Myocardial Infarction and 1-Year Survival JAMA, January 24, 2001; 285(4): 430 - 436. [Abstract] [Full Text] [PDF]
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R.R Azar, S Rinfret, P Theroux, P.H Stone, R Dakshinamurthy, Y.-J Feng, A.H.B Wu, G Range, and D.D Waters A randomized placebo-controlled trial to assess the efficacy of antiinflammatory therapy with methylprednisolone in unstable angina (MUNA trial) Eur. Heart J., December 2, 2000; 21(24): 2026 - 2032. [Abstract] [PDF]
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