Predictive value of high sensitivity C-reactive protein in three-vessel disease patients with and without type 2 diabetes

Cardiovascular Diabetology

Research

Yifan Zhu¹  Junjie Wang²  Bo Zhang²  Yunlong Xia²  Haichen Lv²  Xuchen Zhou²  Lei Guo²  Hao Zhu²  Xiaoyan Zhang³ 

[1]Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China

[2]Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian, People’s Republic of China

[3]Department of Radiology, Fuyang Hospital of Anhui Medical University, Fuyang, People’s Republic of China

关键词: High-sensitivity C-reactive protein;    Three-vessel disease;    Diabetes;    Coronary artery disease;    Outcomes;   

DOI  :  10.1186/s12933-023-01830-7

 received in 2023-03-08, accepted in 2023-04-08,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundDiabetes mellitus (DM) and atherosclerosis are multifactorial conditions and share a common inflammatory basis. Three-vessel disease (TVD) represents a major challenge for coronary intervention. Nonetheless, the predictive value of high-sensitivity C-reactive protein (hs-CRP) for TVD patients with or without type 2 DM remains unknown. Herein, we aimed to ascertain the long-term predictive value of hs-CRP in TVD patients according to type 2 DM status from a large cohort.MethodsA total of 2734 TVD patients with (n = 1040, 38%) and without (n = 1694, 62%) type 2 diabetes were stratified based on the hs-CRP (< 2 mg/L vs. ≥ 2 mg/L). Three multivariable analysis models were performed to evaluate the effect of potential confounders on the relationship between hs-CRP level and clinical outcomes. The Concordance index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess the added effect of hs-CRP and the baseline model with established risk factors on the discrimination of clinical outcomes. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE).ResultsThe median follow-up duration was 2.4 years. Multivariate Cox regression analyses showed that the incidence of MACCE (adjusted hazard ratio [HR] 1.17, 95% confidence interval [CI] 1.01–1.35, p = 0.031) and all-cause death (HR 1.82, 95% CI 1.07–3.11, p = 0.026) were significantly higher in the diabetic group compared to the non-diabetic group. In the diabetic group, the incidence of MACCE (adjusted HR 1.51, 95% CI 1.09–2.10, p = 0.013) was significantly higher in the high hs-CRP group than in the low hs-CRP group; no significant difference was found for all-cause death (HR 1.63; 95% CI 0.58–4.58, p = 0.349). In the non-diabetic group, the prevalence of MACCE (adjusted HR 0.93, 95% CI 0.71–1.22, p = 0.613) was comparable between the two groups. Finally, the NRI (0.2074, p = 0.001) and IDI (0.0086, p = 0.003) for MACCE were also significantly increased after hs-CRP was added to the baseline model in the diabetic group.ConclusionsElevated hs-CRP is an independent prognostic factor for long-term outcomes of MACCE in TVD patients with type 2 diabetes but not in those without type 2 diabetes. Compared to traditional risk factors, hs-CRP improved the risk prediction of adverse cardiovascular events in TVD patients with type 2 diabetes.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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