C-reactive protein predicts further ischemic events in first-ever transient ischemic attack or stroke patients with intracranial large-artery occlusive disease

被引:162
作者
Arenillas, JF
Alvarez-Sabín, J
Molina, CA
Chacón, P
Montaner, J
Rovira, A
Ibarra, B
Quintana, M
机构
[1] Vall Hebron Hosp, Dept Neuroradiol, Neurovasc Unit, Barcelona, Spain
[2] Vall Hebron Hosp, Dept Neuroradiol, Lipid Res Unit, Barcelona, Spain
[3] Vall Hebron Hosp, Dept Neuroradiol, Magnet Resonance Unit, Barcelona, Spain
[4] Vall Hebron Hosp, Dept Neuroradiol, Computed Tomog Unit, Barcelona, Spain
关键词
atherosclerosis; C-reactive protein; outcome; stenosis; stroke;
D O I
10.1161/01.STR.0000089920.93927.A7
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-The role of inflammation in intracranial large-artery occlusive disease is unclear. We sought to investigate the relationship between high-sensitivity C-reactive protein (CRP) levels and the risk of further ischemic events in first-ever transient ischemic attack (TIA) or stroke patients with intracranial large-artery occlusive disease. Methods-Of a total of 127 consecutive first-ever TIA or ischemic stroke patients with intracranial stenoses detected by transcranial Doppler ultrasonography, 71 fulfilled all inclusion criteria, which included angiographic confirmation. Serum high-sensitivity CRP level was determined a minimum of 3 months after the qualifying event. Patients were followed up during 1 year after blood sampling. Results-Thirteen patients (18.3%) with intracranial large-artery occlusive disease experienced an end point event: 9 cerebral ischemic events, 7 of which were attributable to intracranial large-artery occlusive disease, and 4 myocardial infarctions. Patients in the highest quintile of high-sensitivity CRP level had a significantly higher adjusted odds ratio for new events compared with those in the first quintile (odds ratio, 8.66; 95% CI, 1.39 to 53.84; P=0.01). A high-sensitivity CRP level above the receiver operating characteristic curve cutoff value of 1.41 mg/dL emerged as an independent predictor of new end point events (hazard ratio, 7.14; 95% CI, 1.77 to 28.73; P=0.005) and of further intracranial large-artery occlusive disease-related ischemic events (hazard ratio, 30.67; 95% CI, 3.6 to 255.5; P=0.0015), after adjustment for age, sex, and risk factors. Kaplan-Meier curves showed that a significantly lower proportion of patients with a high-sensitivity CRP >1.41 mg/dL remained free of a new ischemic event (P<0.0001). Conclusions-High-sensitivity CRP serum level predicts further intracranial large-artery occlusive disease-related and any major ischemic events in patients with first-ever TIA or stroke with intracranial large-artery occlusive disease. These findings are consistent with the hypothesis that inflammation may be involved in the progression and complication of intracranial large-artery occlusive disease.
引用
收藏
页码:2463 / 2468
页数:6
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