Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Associate Professor
|Title||Impact of High-sensitivity C-reactive Protein Level on Clinical Outcomes of Acute Coronary
Syndrome Patients with Dyslipidemia Undergoing Contemporary Lipid-lowering Therapy
|Conference||ACC.18 (67th Annual Scientific Session & Expo)|
|Promoters||American College of Cardiology|
|Conference Type||International society and overseas society|
|Presentation Type||Poster notice|
|Publisher and common publisher||WATANABE Erisa, ◎OGAWA Risa, YAMAGUCHI Junichi, SEKIGUCHI Haruki, OGISO Masastaka, ARASHI Hiroyuki, OGAWA Hiroshi, HAGIWARA Nobuhisa|
(city and name of the country)
|Society abstract||Journal of the American College of Cardiology 71(11),Supplement A53 2018|
|Summary||Background: Few reports elucidate the impact of high sensitivity C reactive protein (hsCRP) level on clinical outcomes in acute coronary syndrome (ACS) patients with dyslipidemia undergoing contemporary pharmacotherapy. We examined the effect of hsCRP in chronic phase of ACS on clinical outcomes in contemporary lipid-lowering therapy.
Methods: In the HIJ PROPER study, a total of 1,734 ACS patients with dyslipidemia were randomly assigned to receive high intensity statin monotherapy or high intensity statin plus ezetimibe. In the present study, participants were divided into subgroups according to quartiles of hsCRP after 3 months of assigned treatment. Primary endpoint was a composite of allcause death, nonfatal myocardial infarction, nonfatal stroke, unstable angina and ischemia driven coronary revascularizations.
Results: Median followup period was 3.9 years and followup rate was 99%. In the present analysis, 1,415 patients were evaluated retrospectively. During the study period, there were no significant differences in serial changes in LDL Cholesterol level among 4 groups (p value 0.44). Kaplan Meier analysis revealed that the incidence of primary endpoint and allcause death was significantly higher in the highest quartile of hsCRP levels than those of other three groups (HR 1.52, 95%CI 1.16 to 2.00, p<0.01 and HR 5.30, 95%CI 2.47 to 11.32, p<0.01, respectively). The cutoff point of 0.74 mg/L of hsCRP for prediction of allcause death was derived from a receiver operating characteristic curve (Sensitivity 68%, Specificity 62%). After multivariate analysis, hsCRP ≥ 0.74 mg/L at 3 month correlated with increased risk of all-cause death (adjusted HR 3.68, 95% CI 2.22 to 6.10, p<0.01).
Conclusion: In ACS patients with dyslipidemia, high hsCRP in a stabilized period with contemporary acute revascularization and pharmacotherapy was an independent predictor of worse clinical outcomes, suggesting that the aggressive intervention for elevated inflammatory biomarkers as well as intensive lipid lowering and coronary revascularization are an encouraging target for secondary prevention in ACS patients with dyslipidemia.