Biological profiles in subjects with recurrent acute coronary events compared with subjects with long-standing stable angina

Background-At one end of the clinical spectrum of coronary artery disease ( CAD) are subjects who have had repeated acute ischemic events, and at the o ther end are those with long-standing angina who have never been unstable, This study tests the hypothesis that a specific biological profile can dist inguish these 2 extreme groups and predict acute coronary events. Methods and Results-Blood levels of lipoprotein(a), homocysteine, tissue pl asminogen activator, plasminogen activator inhibitor-1, C-reactive protein (CRP), fibrinogen, and von Willebrand factor were compared in 3 groups of 5 0 subjects each: (1) those with previous multiple acute coronary events, (2 ) age-matched subjects with greater than or equal to3 years of stable angin a and no prior acute coronary events, and (3) matched controls without evid ence of atherosclerotic disease and a normal coronary angiogram. All subjec ts were followed for 4.0 years. Lipoprotein(a), homocysteine, tissue plasmi nogen activator, and plasminogen activator inhibitor-1 were similar in both CAD groups and significantly higher than in the control group. However, co mpared with subjects with long-standing stable angina, those with previous multiple coronary events had higher values of CRP (5.7 +/-5.4 versus 3.0 +/ -5.2 mg/L, P=0.012), fibrinogen (3.38 +/-0.75 versus 2.92 +/-0.64 g/L, P=0, 001), and von Willebrand factor (1.60 +/-0.55 versus 1.25 +/-0.36 U/mL, P=0 .0003), On follow-up, myocardial infarction and unstable angina occurred in 42% of the group with multiple events, 4% of the stable angina group (P<0. 0001), and none of the control subjects. In the 100 patients with CAD, CRP was 4.9 mg/L in those with and 1.8 mg/L in those without new instability (P <0.0001). In a multivariate analysis, only CRP distinguished those with fol low-up acute coronary events (adjusted odds ratio 5.9, 95% CI 2.0 to 17.9; P=0.002), A baseline CRP >3.5 mg/L had a relative risk of 7.6 (2.6 to 21.7, P=0.0002) for subsequent acute events. Conclusions-An inflammatory biological profile distinguished patients with previous multiple acute coronary events from those with long-standing stabl e angina and predicted acute coronary instability.