دورية أكاديمية
أعرض في EDS

Association of Initial and Serial C-Reactive Protein Levels With Adverse Cardiovascular Events and Death After Acute Coronary Syndrome: A Secondary Analysis of the VISTA-16 Trial.

التفاصيل البيبلوغرافية
العنوان: Association of Initial and Serial C-Reactive Protein Levels With Adverse Cardiovascular Events and Death After Acute Coronary Syndrome: A Secondary Analysis of the VISTA-16 Trial.
المؤلفون: Mani P; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio., Puri R; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio., Schwartz GG; Section of Cardiology, Veterans Affairs Medical Center and University of Colorado, Aurora., Nissen SE; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio., Shao M; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio., Kastelein JJP; Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands., Menon V; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio., Lincoff AM; Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.; Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio., Nicholls SJ; MonashHeart, Monash University, Clayton, Australia.
المصدر: JAMA cardiology [JAMA Cardiol] 2019 Apr 01; Vol. 4 (4), pp. 314-320.
نوع المنشور: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't
اللغة: English
بيانات الدورية: Publisher: American Medical Association Country of Publication: United States NLM ID: 101676033 Publication Model: Print Cited Medium: Internet ISSN: 2380-6591 (Electronic) NLM ISO Abbreviation: JAMA Cardiol Subsets: MEDLINE
أسماء مطبوعة: Original Publication: [Chicago, Illinois] : American Medical Association, [2016]-
مواضيع طبية MeSH: Acute Coronary Syndrome/*blood , Acute Coronary Syndrome/*drug therapy , C-Reactive Protein/*analysis, Acetates/administration & dosage ; Acetates/therapeutic use ; Acute Coronary Syndrome/complications ; Acute Coronary Syndrome/mortality ; Aged ; Angina, Unstable/mortality ; Australia/epidemiology ; C-Reactive Protein/drug effects ; Death ; Europe/epidemiology ; Female ; Humans ; India/epidemiology ; Indoles/administration & dosage ; Indoles/therapeutic use ; Keto Acids ; Male ; Middle Aged ; Myocardial Infarction/mortality ; New Zealand ; North America/epidemiology ; Phospholipase A2 Inhibitors/administration & dosage ; Phospholipase A2 Inhibitors/therapeutic use ; Placebos/administration & dosage ; Risk Factors ; Stroke/mortality ; Treatment Outcome
مستخلص: Importance: Higher baseline high-sensitivity C-reactive protein (hsCRP) levels after an acute coronary syndrome (ACS) are associated with adverse cardiovascular outcomes. The usefulness of serial hsCRP measurements for risk stratifying patients after ACS is not well characterized.
Objective: To assess whether longitudinal increases in hsCRP measurements during the 16 weeks after ACS are independently associated with a greater risk of a major adverse cardiac event (MACE), all-cause death, and cardiovascular death.
Design, Setting, and Participants: Secondary analysis of the double-blind, multicenter, randomized clinical Vascular Inflammation Suppression to Treat Acute Coronary Syndromes for 16 Weeks (VISTA-16) trial conducted between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012), which included 5145 patients from 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America assigned to receive varespladib or placebo on a background of atorvastatin treatment beginning within 96 hours of presentation with an ACS. The present study evaluated data from patients with available baseline and longitudinal hsCRP levels measured at weeks 1, 2, 4, 8, and 16 after randomization to treatment or placebo. Statistical analysis was performed from June 15, 2018, through September 15, 2018.
Main Outcomes and Measures: Outcomes were MACE (composite of cardiovascular death, myocardial infarction, nonfatal stroke, or unstable angina with documented ischemia requiring hospitalization), cardiovascular death, and all-cause death after adjustment for baseline clinical, treatment, and laboratory characteristics, including baseline hsCRP levels.
Results: Among 4257 patients in this study, 3141 (73.8%) were men and the mean age was 60.3 years (interquartile range [IQR], 53.5-67.8 years). The median 16-week low-density lipoprotein cholesterol level was 64.9 mg/dL (IQR, 50.3-82.3 mg/dL), and the median hsCRP level was 2.4 mg/L (IQR, 1.1-5.2 mg/L). On multivariable analysis, higher baseline hsCRP level (hazard ratio [HR], 1.36 [95% CI, 1.13-1.63]; P = .001) and higher longitudinal hsCRP level (HR, 1.15 [95% CI, 1.09-1.21]; P < .001) were independently associated with MACE. Similar significant and independent associations were shown between baseline and longitudinal hsCRP levels and cardiovascular death (baseline: HR, 1.61 per SD [95% CI, 1.07-2.41], P = .02; longitudinal: HR, 1.26 per SD [95% CI, 1.19-1.34], P < .001) and between baseline and longitudinal hsCRP levels and all-cause death (baseline: HR, 1.58 per SD [95% CI, 1.07-2.35], P = .02; longitudinal: HR, 1.25 per SD [95% CI, 1.18-1.32], P < .001).
Conclusions and Relevance: Initial and subsequent increases in hsCRP levels during 16 weeks after ACS were associated with a greater risk of the combined MACE end point, cardiovascular death, and all-cause death despite established background therapies. Serial measurements of hsCRP during clinical follow-up after ACS may help to identify patients at higher risk for mortality and morbidity.
References: Circ Res. 2001 Jul 6;89(1):1-2. (PMID: 11440969)
JAMA. 2001 Apr 4;285(13):1711-8. (PMID: 11277825)
Am Heart J. 2015 Aug;170(2):380-9. (PMID: 26299237)
Am Heart J. 2005 Mar;149(3):451-7. (PMID: 15864233)
Lancet. 1997 Feb 15;349(9050):462-6. (PMID: 9040576)
N Engl J Med. 2005 Jan 6;352(1):20-8. (PMID: 15635109)
N Engl J Med. 2017 Sep 21;377(12):1119-1131. (PMID: 28845751)
Br Heart J. 1982 Mar;47(3):239-43. (PMID: 7059401)
JAMA. 2014 Jan 15;311(3):252-62. (PMID: 24247616)
J Thromb Haemost. 2004 Nov;2(11):1934-40. (PMID: 15550024)
N Engl J Med. 2004 Apr 8;350(15):1495-504. (PMID: 15007110)
J Am Coll Cardiol. 2001 Jun 15;37(8):2036-41. (PMID: 11419884)
Am J Cardiol. 2004 Aug 1;94(3):358-60. (PMID: 15276105)
Lancet. 2018 Jan 27;391(10118):319-328. (PMID: 29146124)
J Am Coll Cardiol. 1998 Jun;31(7):1460-5. (PMID: 9626820)
Heart. 2008 Apr;94(4):457-62. (PMID: 17761503)
Circulation. 2001 Apr 3;103(13):1718-20. (PMID: 11282900)
N Engl J Med. 2004 Dec 16;351(25):2599-610. (PMID: 15602020)
Circulation. 1999 Aug 24;100(8):793-8. (PMID: 10458713)
N Engl J Med. 2001 Jun 28;344(26):1959-65. (PMID: 11430324)
N Engl J Med. 2002 Nov 14;347(20):1557-65. (PMID: 12432042)
Am J Cardiol. 2002 Jan 15;89(2):145-9. (PMID: 11792332)
Circulation. 2003 Sep 30;108(13):1560-6. (PMID: 12975259)
المشرفين على المادة: 0 (Acetates)
0 (Indoles)
0 (Keto Acids)
0 (Phospholipase A2 Inhibitors)
0 (Placebos)
2Q3P98DATH (varespladib)
9007-41-4 (C-Reactive Protein)
تواريخ الأحداث: Date Created: 20190307 Date Completed: 20200203 Latest Revision: 20211204
رمز التحديث: 20221213
مُعرف محوري في PubMed: PMC6484785
DOI: 10.1001/jamacardio.2019.0179
PMID: 30840024
قاعدة البيانات: MEDLINE
الوصف
تدمد:2380-6591
DOI:10.1001/jamacardio.2019.0179