Multiple complex stenoses, high neutrophil count and C-reactive protein levels in patients with chronic stable angina

Inflammation plays an important role in atherosclerosis and the genesis of acute coronary syndromes, i.e., atheromatous plaque disruption. Neutrophil count and C-reactive protein (CRP) levels are markers of ongoing inflammation and predictors of cardiovascular risk. We sought to assess whether these inflammatory markers are associated with the presence of multiple complex stenoses in patients with chronic stable angina. Methods and results: We assessed 150 patients with chronic stable angina, 121 with significant coronary artery stenosis (≥50% diameter reduction) and 29 without. CRP levels and neutrophil count were assessed at study entry. Stenoses were classified as “complex” (irregular or scalloped borders, ulceration or filling defects) or “smooth” (absence of complex features). Eighty-eight percent of the complex lesions were of type C according to AHA/ACC classification whereas the rest were type B. Patients with ≥3 complex lesions were considered to have multiple complex stenoses. Extent of coronary artery disease was assessed using a validated score. Baseline neutrophil count (4.39×109 L−1±1.28 versus 3.82×109 L−1±0.77; P=0.004) and CRP levels (2.15 mg/L (4.6–1) versus 0.39 mg/L (0.69–0.23); P<0.0001) were higher in patients with significant stenoses compared to patients without. No association was found between disease extent and CRP levels or neutrophil count. Neutrophil count, however (but not CRP) correlated with stenosis complexity (r=0.28; P=0.002) and was also an independent predictor of the presence of multiple complex stenoses (OR: 4.05; CI 95% (1.9–10.4); P=0.038). Conclusions: CRP levels and neutrophil count are higher in angina patients with coronary stenoses compared to those without. Neutrophil count, but not CRP levels, correlates with angiographic stenosis complexity.