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High-sensitivity (hs)CRP is an inflammatory marker indicative of higher cardiovascular (CV) risk among pts with established atherosclerosis. It is unknown whether changes in hsCRP over time in stable pts with atherosclerosis are related to long-term outcomes.
TRA2°P-TIMI 50 was a large, multinational trial in 26,449 pts with stable atherosclerosis, manifest by prior MI, stroke or PAD. hsCRP was measured at baseline & 30 days in all pts. CV outcomes were evaluated by hsCRP at baseline and by change over time (baseline to 30 days) with a landmark analysis from 30 days to 3 yr.
Recurrent CV events were more likely in pts with high baseline hsCRP (≥2mg/L) compared with low hsCRP (<2mg/L), including CV death/MI/stroke (11.5% vs. 8.4%, HR 1.37, p=<0.001), and other CV outcomes (Fig-L). Pts with hsCRP that increased over the first 30 days (Low-High, HR 1.26, p=0.004) or remained high (High-High, HR 1.55, p=<0.001) had a significantly increased risk of CVD/MI/stroke compared to pts who maintained or fell from high to low hsCRP levels (Fig-R). The reduction in CVD/MI/stroke with vorapaxar vs. placebo (HR 0.87, p=<0.001) did not vary with baseline hsCRP (p-interaction=0.63).
In this large cohort with stable atherosclerosis, baseline hsCRP and change in hsCRP identified patients at higher CV risk. Serial measurements provided incremental information to the baseline assessment of hsCRP.
Poster Sessions, Expo North
Saturday, March 09, 2013, 3:45 p.m.-4:30 p.m.
Session Title: What's New with Risk Stratification in SIHD: Biomarkers, Genes and ECG
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1154-72
- 2013 American College of Cardiology Foundation