Associations between C-reactive protein and circulating cell adhesion molecules in patients with unstable angina undergoing coronary intervention and their clinical implication.

BACKGROUND

There is growing evidence that C-reactive protein (CRP) may have a direct role in the pathogenesis of atherosclerosis.

HYPOTHESIS: The purpose of this study was to assess associations between CRP and adhesion molecules and to determine the prognostic value of adhesion molecules as a predictor of cardiac events in patients with unstable angina.

METHODS

Fifty-five consecutive patients (33 males, mean age 61 years) with unstable angina (Braunwald class IIb or IIIb) undergoing coronary stenting were included in this study.

RESULTS

The test for a trend toward increasing intercellular adhesion molecule (ICAM)-1 concentrations by the 75th percentile of CRP levels at 72 h after coronary stenting was significant (p = 0.03). At 72 h after coronary stenting, CRP levels were the only determinants of ICAM-1 concentrations by multiple linear regression analysis. An elevated level of CRP (>5.4 mg/l) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.3-3.7, p < 0.05) and ICAM-1 (>321 ng/ml) (OR 1.2, 95% CI 1.1-2.1, p < 0.05) at 72 h after coronary stenting is an independent risk factor for an adverse cardiac event.

CONCLUSIONS

These results suggest that in patients with unstable angina undergoing coronary stenting, the measurements of inflammatory parameters, especially CRP and ICAM-1, may be useful for identifying those at higher risk of a cardiac event, and CRP may play a direct role in promoting the inflammatory component of atherosclerosis by inducing significant expression of ICAM-1.