Predictive Value of Baseline High-Sensitivity C-Reactive Protein Level and Renal Function for Patients With Acute Coronary Syndrome Undergoing Aggressive Lipid-Lowering Therapy: A Subanalysis of HIJ-PROPER.

The systematic inflammatory response might confound renal impairment, and both have been reported to affect clinical outcomes after acute coronary syndrome. We examined the impacts of the high-sensitivity C-reactive protein (hsCRP) level and estimated glomerular filtration rate level on the prognosis for acute coronary syndrome patients who underwent aggressive lipid-lowering therapy in contemporary practice. This was a subanalysis of the HIJ-PROPER study, and 1,734 patients were enrolled. Patients were divided into 4 groups using an hsCRP value of 10mg/L and an estimated glomerular filtration rate value of 60 ml/min/1.73 m2 as the cut-off points. Groups were defined as follows: group A, low hsCRP and normal or mild renal impairment; group B, low hsCRP and renal impairment; group C, high hsCRP and normal or mild renal impairment; and group D, high hsCRP and renal impairment. The primary end point was defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and unstable angina or coronary revascularizations. The median follow-up period was 3.9years, and the follow-up rate was 99%. Compared with group A, the 2 higher hsCRP groups (groups C and D) showed a significantly higher incidence of primary end points (hazard ratio 1.36, 95% confidence interval 1.12 to 1.65, p = 0.002; and hazard ratio 1.40, 95% CI 1.10 to 1.80, p = 0.008). Such a difference was not found compared with group B. In conclusion, patients with higher hsCRP levels had worse prognoses regardless of renal impairment and aggressive lipid-lowering therapy.