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Relationships of hsCRP to High-Risk Vulnerable Plaque After NSTEMI : Insights From the PROSPECT II Trial

Fröbert, Ole ; Stone, Gregg W. ; Larsen, Alf Inge ; Zhou, Zhipeng ; Kotinkaduwa, Lak N. ; Engstrøm, Thomas LU ; Kjøller-Hansen, Lars ; Maeng, Michael ; Matsumura, Mitsuaki and Ben-Yehuda, Ori , et al. (2025) In JACC: Cardiovascular Interventions 18(10). p.1217-1228
Abstract

Background: Inflammation is a driver of atherosclerosis and susceptibility to cardiovascular events. Objectives: The authors sought to evaluate whether high-sensitivity C-reactive protein (hsCRP) levels are associated with the prevalence of high-risk coronary plaques in patients with non–ST-segment elevation myocardial infarction (NSTEMI). Methods: PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II was a multicenter, prospective study enrolling patients with recent myocardial infarction. Following treatment of all flow-limiting lesions, 3-vessel imaging with near-infrared spectroscopy and intravascular ultrasound was used to characterize untreated nonculprit lesions. We investigated the... (More)

Background: Inflammation is a driver of atherosclerosis and susceptibility to cardiovascular events. Objectives: The authors sought to evaluate whether high-sensitivity C-reactive protein (hsCRP) levels are associated with the prevalence of high-risk coronary plaques in patients with non–ST-segment elevation myocardial infarction (NSTEMI). Methods: PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II was a multicenter, prospective study enrolling patients with recent myocardial infarction. Following treatment of all flow-limiting lesions, 3-vessel imaging with near-infrared spectroscopy and intravascular ultrasound was used to characterize untreated nonculprit lesions. We investigated the association between baseline hsCRP and plaque morphology (lipid content, plaque burden, lumen area) in 501 NSTEMI patients. hsCRP levels were categorized as low (<1 mg/L), intermediate (1-3 mg/L), or high (>3 mg/L). Results: The percentages of patients with at least 1 highly lipidic plaque (maximum lipid core burden index for any 4-mm pullback length ≥324.7) increased from 39.4% to 57.2% to 59.3% in the low, intermediate, and high hsCRP groups, respectively (P = 0.01). The proportion of patients with at least 1 highly lipidic plaque with ≥70% burden increased with hsCRP levels from 22.7% to 27.2% to 36.7%, respectively (P = 0.01). Multivariable analyses showed that increasing hsCRP was associated with higher total coronary artery lipid core burden index and plaque volume. Higher hsCRP increased the odds of having any highly lipidic plaque and those with ≥70% plaque burden. Conclusions: Among patients with recent NSTEMI, a high baseline hsCRP level was associated with the presence of pan-coronary atherosclerosis and focal high-risk plaques.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
atherosclerosis, cardiovascular event(s), coronary plaques, inflammation, intravascular ultrasound, myocardial infarction, near-infrared spectroscopy, non–ST-segment elevation myocardial infarction
in
JACC: Cardiovascular Interventions
volume
18
issue
10
pages
12 pages
publisher
Elsevier
external identifiers
  • pmid:40272345
  • scopus:105004884566
ISSN
1936-8798
DOI
10.1016/j.jcin.2025.01.440
language
English
LU publication?
yes
id
739e6768-fbd5-4a47-b8bc-9e1005b047aa
date added to LUP
2025-08-01 12:15:03
date last changed
2025-08-01 12:15:58
@article{739e6768-fbd5-4a47-b8bc-9e1005b047aa,
  abstract     = {{<p>Background: Inflammation is a driver of atherosclerosis and susceptibility to cardiovascular events. Objectives: The authors sought to evaluate whether high-sensitivity C-reactive protein (hsCRP) levels are associated with the prevalence of high-risk coronary plaques in patients with non–ST-segment elevation myocardial infarction (NSTEMI). Methods: PROSPECT (Providing Regional Observations to Study Predictors of Events in the Coronary Tree) II was a multicenter, prospective study enrolling patients with recent myocardial infarction. Following treatment of all flow-limiting lesions, 3-vessel imaging with near-infrared spectroscopy and intravascular ultrasound was used to characterize untreated nonculprit lesions. We investigated the association between baseline hsCRP and plaque morphology (lipid content, plaque burden, lumen area) in 501 NSTEMI patients. hsCRP levels were categorized as low (&lt;1 mg/L), intermediate (1-3 mg/L), or high (&gt;3 mg/L). Results: The percentages of patients with at least 1 highly lipidic plaque (maximum lipid core burden index for any 4-mm pullback length ≥324.7) increased from 39.4% to 57.2% to 59.3% in the low, intermediate, and high hsCRP groups, respectively (P = 0.01). The proportion of patients with at least 1 highly lipidic plaque with ≥70% burden increased with hsCRP levels from 22.7% to 27.2% to 36.7%, respectively (P = 0.01). Multivariable analyses showed that increasing hsCRP was associated with higher total coronary artery lipid core burden index and plaque volume. Higher hsCRP increased the odds of having any highly lipidic plaque and those with ≥70% plaque burden. Conclusions: Among patients with recent NSTEMI, a high baseline hsCRP level was associated with the presence of pan-coronary atherosclerosis and focal high-risk plaques.</p>}},
  author       = {{Fröbert, Ole and Stone, Gregg W. and Larsen, Alf Inge and Zhou, Zhipeng and Kotinkaduwa, Lak N. and Engstrøm, Thomas and Kjøller-Hansen, Lars and Maeng, Michael and Matsumura, Mitsuaki and Ben-Yehuda, Ori and Bøtker, Hans Erik and Persson, Jonas and Wiseth, Rune and Jensen, Lisette O. and Nordrehaug, Jan E. and Trovik, Thor and Jensen, Ulf and Bleie, Øyvind and James, Stefan K. and Ali, Ziad A. and Omerovic, Elmir and Erlinge, David and Maehara, Akiko}},
  issn         = {{1936-8798}},
  keywords     = {{atherosclerosis; cardiovascular event(s); coronary plaques; inflammation; intravascular ultrasound; myocardial infarction; near-infrared spectroscopy; non–ST-segment elevation myocardial infarction}},
  language     = {{eng}},
  number       = {{10}},
  pages        = {{1217--1228}},
  publisher    = {{Elsevier}},
  series       = {{JACC: Cardiovascular Interventions}},
  title        = {{Relationships of hsCRP to High-Risk Vulnerable Plaque After NSTEMI : Insights From the PROSPECT II Trial}},
  url          = {{http://dx.doi.org/10.1016/j.jcin.2025.01.440}},
  doi          = {{10.1016/j.jcin.2025.01.440}},
  volume       = {{18}},
  year         = {{2025}},
}