Association between high-sensitivity C-reactive protein and bleeding in dual antiplatelet therapy age: a retrospective observational study

• Published in: BMJ open Vol. 15; no. 2; p. e082900
• Main Authors: He, Wen-fei, Zeng, Li-huan, Lin, Zi-jing, Chen, Peng-yuan, Liu, Yuan-hui, Duan, Chongyang, Jiang, Lei, Guo, Zhi-qiang, He, Peng-cheng
• Format: Journal Article
• Language: English
• Published: England British Medical Journal Publishing Group 12.02.2025; BMJ Publishing Group LTD; BMJ Publishing Group
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Aged; Anemia; Angina pectoris; Biomarkers - blood; Bleeding disorders & coagulopathies; C-reactive protein; C-Reactive Protein - analysis; C-Reactive Protein - metabolism; Cardiac arrhythmia; Cardiovascular Disease; Cardiovascular Medicine; China - epidemiology; Clinical outcomes; Coronary heart disease; Coronary vessels; Diabetes; Dual Anti-Platelet Therapy - adverse effects; Female; Heart attacks; Hemoglobin; Hemorrhage - blood; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Hypertension; Inflammation; Ischemia; Male; Middle Aged; Myocardial infarction; Observational studies; Original Research; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Proteins; Retrospective Studies; Risk Factors; Statistical analysis; Stroke; Trends; Variables; China; Cardiovascular Disease; Myocardial infarction; Coronary heart disease; Risk Factors; Bleeding disorders & coagulopathies
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2023-082900

ObjectivesThe aim of the present study was to investigate the association of high-sensitivity C-reactive protein (hs-CRP) with bleeding events among patients with acute coronary syndrome (ACS) received dual antiplatelet therapy (DAPT) after percutaneous coronary intervention.DesignAn observational and multicentre study was conducted among non-ST-segment elevation ACS (NSTE-ACS).SettingThe study was conducted at five medical centres in China.ParticipantsThis study retrospectively included 2583 adults with NSTE-ACS between 1 January 2010 and 31 December 2014.Primary and secondary outcome measuresThe primary outcome was major bleeding, defined by the Bleeding Academic Research Consortium definition (grades 3–5). The second outcome was death and any bleeding.Results53 (2.1%) patients experienced major bleeding in the hospital. Patients with hs-CRP levels greater than 8.20 mg/L had the highest incidence of in-hospital major bleeding (25 (3.9%), p<0.001) compared with the other groups. Multivariable analysis indicated that hs-CRP was an independent factor associated with in-hospital major bleeding (continuous: adjusted OR=1.01, 95% CI: 1.01 to 1.02, p<0.001; quartiles: adjusted OR for quartile 4 (referring to quartile 1) =3.71, 95% CI: 1.35~10.23, p=0.011), which was further confirmed by subgroup analysis and receiver operating characteristic curves. The restricted cubic spline analysis demonstrated an S-shaped association between hs-CRP and major bleeding. During the 5-year follow-up, there was a significantly high risk of bleeding in patients with higher hs-CRP levels.ConclusionsSystemic inflammation marker hs-CRP in patients with NSTE-ACS who received DAPT is associated with a high risk of in-hospital major bleeding. An S-shaped association was found between hs-CRP and bleeding events. Further studies are warranted to optimise antithrombotic drug therapy in high bleeding risk patients during follow-up.