Can C-Reactive Protein and Fibrinogen Predict Major Adverse Cardiac Events in Cardiovascular and Cerebrovascular Patients?

Abstract

Background: We aimed to examine the value of C-reactive protein (CRP) and fibrinogen levels to predict cardiovascular events and compare their predicting power between patients with a history of the acute coronary syndrome, patients with a history of stroke (ischemic type), and healthy individuals. Methods: This case-control study assessed 79 patients with a history of the acute coronary syndrome and 88 patients with a history of stroke (cerebral ischemia) occurring at least 3 months previously. The patients were selected and followed up from September 2013 to September 2014 for 3 and 6 months after initial assessment to determine 6-month major adverse cardiac events ( MACE). The serum levels of CRP and fibrinogen were measured using ELISA kits. Results: The serum CRP level was significantly higher in the group with the acute coronary syndrome than in the group with a history of stroke and in the healthy group (P=0.045). The Cox regression model showed increased levels of CRP (HR=1.29 1.01-1.66; P=0.038) and fibrinogen (HR=1.01 1.01-1.02; P<0.001) in the group with a history of the acute coronary syndrome. It also demonstrated increased levels of CRP (HR=1.61 0.97-2.67; P=0.065) and fibrinogen (HR=1.02 1.01-1.04; P=0.010) in the stroke group and increased levels of CRP (HR=2.06 0.71-5.99; P=0.183) and fibrinogen (HR=1.01 0.99-1.04; P=0.294) in the normal group. Consequently, the groups with a history of the acute coronary syndrome and a history of stroke effectively predicted 6-month MACE in the crude and age- and sex-adjusted models. Conclusions: Our study achieved 2 important findings. First, our results showed that higher values of these biomarkers were able to predict MACE, even after the inclusion of baseline covariates. Increased levels of CRP and fibrinogen, measured after evaluating the acute phase and their related outcome, were able to predict recurrent cardiovascular events in the patients with a history of cerebrovascular ischemia and the acute coronary syndrome. In addition, there were higher levels of both CRP and fibrinogen markers in the patients with a history of the acute coronary syndrome and stroke than in the healthy individuals.