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(Stroke. 2003;34:2463.)
© 2003 American Heart Association, Inc.

Original Contributions

C-Reactive Protein Predicts Further Ischemic Events in First-Ever Transient Ischemic Attack or Stroke Patients With Intracranial Large-Artery Occlusive Disease

Juan F. Arenillas, MD; José Álvarez-Sabín, MD, PhD; Carlos A. Molina, MD, PhD; Pilar Chacón, MD, PhD; Joan Montaner, MD, PhD; Álex Rovira, MD; Bernardo Ibarra, MD Manuel Quintana

From the Neurovascular Unit (J.F.A., J.A-S., C.A.M., J.M., M.Q.); Lipid Research Unit (P.C.); and Magnetic Resonance (A.R.) and Computed Tomography Unit (B.I.), Department of Neuroradiology, Vall d’Hebron Hospital, Barcelona, Spain.

Correspondence to Juan F. Arenillas Lara, MD, Neurovascular Unit, Department of Neurology, Hospital Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain. E-mail juanfarenillas{at}terra.es

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.

Key Words: atherosclerosis • C-reactive protein • outcome • stenosis • stroke

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