C-reactive protein and multiple complex coronary artery plaques in patients with primary unstable angina

The aim of this study was to investigate the possible association of plasma C-reactive protein (CRP) levels with the presence of angiographically multiple complex lesions (CLs) in patients with primary unstable angina (PUA). For the purpose of this study, 228 consecutive patients with PUA who underwent in-hospital catheterization were evaluated. Plasma CRP levels were measured upon patients’ admission. Coronary plaques were classified as CL or non-CL according to Ambroseʹs criteria. There were 100 (43.9%) patients with no or one CL ( 1) and 128 (56.1%) patients with multiple CLs ( 2). Tertiles of plasma CRP levels upon admission were significantly associated with the number of CLs on angiographic studies. In particular there was a significant gradual increase in either the number of CLs, or the presence of apparently thrombus-containing CLs with increasing of CRP tertiles. By multivariate analysis CRP was independently associated with the presence of either multiple CLs (R.R.=1.8, 95%CI=1.5–2.2, P<0.001), or angiographically apparent thrombus-containing CLs (R.R.=1.4, 95%CI=1.2–1.7, P=0.03). High plasma levels of CRP may reflect a multifocal activation of the coronary tree in patients with PUA. This finding suggests a generalized inflammatory reaction throughout the coronary tree in these patients.