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Tokuda K, Tanaka A, Tobe A, Shirai Y, Kurobe M, Kubota Y, Kunieda T, Miyazaki T, Mizutani K, Furusawa K, Ishii H, Murohara T. Impact of C-Reactive Protein on Long-Term Cardiac Events in Stable Coronary Artery Disease Patients with Chronic Kidney Disease. J Atheroscler Thromb 2023; 30:1635-1643. [PMID: 36908149 PMCID: PMC10627763 DOI: 10.5551/jat.64047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/21/2023] [Indexed: 03/13/2023] Open
Abstract
AIM Chronic inflammation is associated with atherosclerosis development. Chronic kidney disease (CKD) is an independent risk factor for cardiovascular events and is associated with chronic inflammation. We aimed to investigate the influence of C-reactive protein (CRP), an important marker of inflammation, on the clinical outcomes of patients with CKD and stable coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI). METHODS Among patients with stable CAD and CKD who underwent PCI, 516 patients whose CRP levels were available before the PCI procedure were identified. The patients were divided into two groups according to the CRP levels: those with CRP ≥ 2.0 mg/L (high-CRP group) and those with CRP <2.0 mg/L (low-CRP group). The primary endpoint of this study was the occurrence of major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, and unplanned revascularization. RESULTS Overall, the mean age of the patients was 72.5±9.7 years, and 20.7% were female. The median CRP level was 1.43 mg/L (0.6-4.9 mg/L). The median follow-up period was 3.6 years. The occurrence of MACE was significantly higher in the high-CRP group than in the low-CRP group (log-rank p<0.001). Notably, the incidence rate of cardiac death was significantly higher in the high-CRP group (log-rank p<0.001). According to the multivariable analysis, CRP level ≥ 2.0 mg/L was found to be a significant predictor of MACE (hazard ratio [HR]: 1.54, 95% confidence interval [CI]: 1.04-2.28, p=0.003), as well as estimated glomerular filtration rate (HR: 0.98, 95% CI: 0.97-0.99, p<0.01). CONCLUSION High-CRP levels adversely affect long-term cardiac events in patients with stable CAD and CKD.
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Affiliation(s)
- Kotaro Tokuda
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Akihiro Tobe
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Masanari Kurobe
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Tatsuya Miyazaki
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Koji Mizutani
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
- Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University graduate school of medicine, Nagoya, Japan
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Han E, Fritzer-Szekeres M, Szekeres T, Gehrig T, Gyöngyösi M, Bergler-Klein J. Comparison of High-Sensitivity C-Reactive Protein vs C-reactive Protein for Cardiovascular Risk Prediction in Chronic Cardiac Disease. J Appl Lab Med 2022; 7:1259-1271. [DOI: 10.1093/jalm/jfac069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/08/2022] [Indexed: 12/21/2022]
Abstract
Abstract
Background
High-sensitivity C-reactive protein (hs-CRP) is a biomarker used for risk prediction for cardiovascular disease by assessing low concentration of inflammation. Measurements of regular CRP have become very sensitive with a lower detection limit of 0.3 mg/L. This study aimed to compare and explore the association between CRP and hs-CRP.
Methods
Data from 607 consecutive patients referred for cardiovascular risk assessment with hs-CRP were reviewed retrospectively. In total, 570 patients were included in the analysis and classified into 3 (low-, medium-, and high-risk) groups (hs-CRP cutoff: <1, 1–3, >3 mg/L). Correlation between hs-CRP and CRP was assessed with the kappa statistic and visualized with a Bland–Altman plot. The association between hs-CRP and occurrence of the composite outcome (acute myocardial infarction, stroke, coronary intervention [percutaneous coronary intervention or bypass surgery], or death) was determined with Cox regression analysis and visualized with Kaplan–Meier curves.
Results
A total number reclassification occurred in 8.6% of the cases for CRP risk groups, which demonstrates an agreement of 91.4% (kappa 0.87; P < 0.001). The correlation between CRP and hs-CRP was significant (P < 0.001), Spearman regression R2 = 0.98. A Bland–Altman plot displayed an average difference of 0.19 mg/L (95%CI, 0.17 to 0.23) between the CRP and hs-CRP. Cardiovascular events were more likely to occur in patients who were older, with hs-CRP or CRP >3 mg/L and a history of coronary artery disease.
Conclusions
The usual laboratory tests for CRP values in the lower range highly correlate with the hs-CRP tests and can therefore replace the costlier hs-CRP measurements.
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Affiliation(s)
- Emilie Han
- Department of Cardiology, Medical University of Vienna , 1090 Vienna , Austria
| | | | - Thomas Szekeres
- Department of Laboratory Medicine, Medical University of Vienna , 1090 Vienna , Austria
| | - Teresa Gehrig
- Faculty of Business, Economics and Statistics, University of Vienna , 1090 Vienna , Austria
| | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna , 1090 Vienna , Austria
| | - Jutta Bergler-Klein
- Department of Cardiology, Medical University of Vienna , 1090 Vienna , Austria
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Vasudevan A, Tecson KM, Bennett-Firmin J, Bottiglieri T, Lopez LR, Peterson M, Sathyamoorthy M, Schiffmann R, Schussler JM, Swift C, Velasco CE, McCullough PA. Prognostic value of urinary 11-dehydro-thromboxane B 2 for mortality: A cohort study of stable coronary artery disease patients treated with aspirin. Catheter Cardiovasc Interv 2018; 92:653-658. [PMID: 29193683 DOI: 10.1002/ccd.27437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 10/17/2017] [Accepted: 11/04/2017] [Indexed: 11/07/2022]
Abstract
AIM There is a variable cardiovascular risk reduction attributable to aspirin because of individual differences in the suppression of thromboxane A2 and its downstream metabolite 11-dehydro-thromboxane B2 (11dhTxB2 ). The aim of this study is to evaluate the optimal cut point of urinary 11dhTxB2 for the risk of mortality in aspirin-treated coronary artery disease (CAD) patients. METHODS AND RESULTS This was a prospective cohort study including stable CAD patients who visited the Baylor Heart and Vascular Hospital in Dallas or the Texas Heart Hospital Baylor Plano, TX between 2010 and 2013. The outcome of all-cause mortality was ascertained from chart review and automated sources. The 449 patients included in this analysis had a mean age of 66.1 ± 10.1 years. 67 (14.9%) patients died within 5 years; 56 (87.5%) of the 64 patients with known cause of death suffered a cardiovascular related mortality. Baseline ln(urinary 11dhTxB2 /creatinine) ranged between 5.8 and 11.1 (median = 7.2) with the higher concentrations among those who died (median: 7.6) than those who survived (median = 7.2, P < 0.001). Using baseline ln(11dhTxB2 ) to predict all-cause mortality, the area under the curve was 0.70 (95% CI: 0.64-0.76). The optimal cut point was found to be ln(7.38) = 1597.8 pg/mg, which had the following decision statistics: sensitivity = 0.67, specificity = 0.62, positive predictive value = 0.24, negative predictive value = 0.92, and accuracy = 0.63. CONCLUSION Our data indicate the optimal cut point for urine 11dhTxB2 is 1597.8 (pg/mg) for the risk prediction of mortality over five years in stable patients with CAD patients treated with aspirin.
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Affiliation(s)
- Anupama Vasudevan
- Baylor Heart and Vascular Institute, Baylor Research Institute, Dallas, Texas.,Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas
| | - Kristen M Tecson
- Baylor Heart and Vascular Institute, Baylor Research Institute, Dallas, Texas.,Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas
| | | | | | | | - Margarita Peterson
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Mohanakrishnan Sathyamoorthy
- Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, Baylor All Saints Medical Center, Fort Worth, Texas
| | - Raphael Schiffmann
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Jeffrey M Schussler
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Caren Swift
- Institute of Metabolic Disease, Baylor Research Institute, Dallas, Texas
| | - Carlos E Velasco
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas
| | - Peter A McCullough
- Department of Medicine, Texas A&M Health Science Center College of Medicine, Dallas Campus, Texas.,Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Baylor University Medical Center, Dallas, Texas.,Division of Cardiology, The Heart Hospital Baylor Plano, Texas
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Rosuvastatin Improves Vaspin Serum Levels in Obese Patients with Acute Coronary Syndrome. Diseases 2018; 6:diseases6010009. [PMID: 29337850 PMCID: PMC5871955 DOI: 10.3390/diseases6010009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 12/27/2022] Open
Abstract
Adipose tissue-derived serine protease inhibitor (vaspin), which has endocrine and local roles in atherosclerosis growth, is also synthesized by adipose tissue; it was found that vaspin was negatively correlated with blood pressure in obese patients, while vaspin levels were decreased in endothelial dysfunction. The aim of the present study was to determine rosuvastatin modulation effects on serum vaspin levels in acute coronary syndrome (ACS) with class I obesity. A total number of seventy patients with acute coronary syndrome previously and currently treated with rosuvastatin was compared to 40 patients with IHD not treated by rosuvastatin as a control. Vaspin serum levels were higher in rosuvastatin-treated patients with acute coronary syndrome compared to the patients with acute coronary syndrome not treated by rosuvastatin, p < 0.01. Additionally, in the rosuvastatin-treated group, patients with STEMI showed higher vaspin serum levels compared to NSTEMI p < 0.01. Conclusion: Rosuvastatin significantly increases vaspin serum levels in acute coronary syndrome.
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Wang A, Liu J, Li C, Gao J, Li X, Chen S, Wu S, Ding H, Fan H, Hou S. Cumulative Exposure to High-Sensitivity C-Reactive Protein Predicts the Risk of Cardiovascular Disease. J Am Heart Assoc 2017; 6:e005610. [PMID: 29066453 PMCID: PMC5721824 DOI: 10.1161/jaha.117.005610] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 08/03/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND One measurement of hs-CRP (high-sensitivity C-reactive protein) is associated with increased risk of cardiovascular disease (CVD). The objective of this study was to characterize the association of cumulative exposure to increased hs-CRP with incident cardiovascular events. METHODS AND RESULTS We included 53 065 participants with hs-CRP measured at 3 examinations in 2006, 2008, and 2010. Cumulative exposure to hs-CRP was calculated as the weighted sum of the average hs-CRP level for each time interval (level×time). Participants were classified into nonexposed group (hs-CRP<3.0 mg/L in all 3 examinations), 1-exposed group (hs-CRP≥3.0 mg/L in 1 of the 3 examinations), 2-exposed group (hs-CRP≥3.0 mg/L in 2 of the 3 examinations), and 3-exposed group (hs-CRP≥3.0 mg/L in 3 examinations). Cox proportional hazards models were used to assess the association of cumulative hs-CRP with incident CVD. The study showed a dose-response pattern with risk of CVD and myocardial infarction as the number of years of exposure to hs-CRP increases. Participants in the 3-exposed group had significantly increased CVD risk with hazard ratio (95% confidence interval) of 1.38 (1.11-1.72), in comparison with 1.28 (1.07-1.52) for participants in the 2-exposed group and 1.13 (0.97-1.31) for those in the 1-exposed group (P<0.05); meanwhile, the similar and significant associations were also observed for myocardial infarction with respective hazard ratio (95% confidence interval) of 2.13 (1.42-3.18), 1.60 (1.12-2.27), and 1.57 (1.17-2.10). The associations between stroke and cumulative hs-CRP were not statistically significant (P=0.360). CONCLUSIONS Cumulative exposure to hs-CRP was dose dependently associated with a subsequent increased risk of CVD and myocardial infarction. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: ChiCTR-TNC-11001489.
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Affiliation(s)
- Aitian Wang
- Tianjin Medical University, Tianjin, China
- Department of Intensive medicine, Kailuan General Hospital, Tangshan, China
- Key Laboratory of Emergency and Disaster Medicine in Chinese People's Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People's Army Police Forces, Tianjin, China
| | - Jie Liu
- Department of Cardiology, Affiliated Hospital of North China University of Science and Technology, Tangshan, China
| | - Chunguang Li
- Department of Cardiology, Tangshan Workers' Hospital, Tangshan, China
| | - Jingli Gao
- Department of Intensive medicine, Kailuan General Hospital, Tangshan, China
| | - Xiaolan Li
- Department of Intensive medicine, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Hui Ding
- Key Laboratory of Emergency and Disaster Medicine in Chinese People's Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People's Army Police Forces, Tianjin, China
| | - Haojun Fan
- Key Laboratory of Emergency and Disaster Medicine in Chinese People's Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People's Army Police Forces, Tianjin, China
| | - Shike Hou
- Key Laboratory of Emergency and Disaster Medicine in Chinese People's Liberation Army, Institute of Disaster Medicine and Public Health, Affiliated Hospital of Logistics University of Chinese People's Army Police Forces, Tianjin, China
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Lindholm D, Lindbäck J, Armstrong PW, Budaj A, Cannon CP, Granger CB, Hagström E, Held C, Koenig W, Östlund O, Stewart RA, Soffer J, White HD, de Winter RJ, Steg PG, Siegbahn A, Kleber ME, Dressel A, Grammer TB, März W, Wallentin L. Biomarker-Based Risk Model to Predict Cardiovascular Mortality in Patients With Stable Coronary Disease. J Am Coll Cardiol 2017; 70:813-826. [DOI: 10.1016/j.jacc.2017.06.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/12/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
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7
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Preprocedural C-Reactive Protein Predicts Outcomes after Primary Percutaneous Coronary Intervention in Patients with ST-elevation Myocardial Infarction a systematic meta-analysis. Sci Rep 2017; 7:41530. [PMID: 28128312 PMCID: PMC5270244 DOI: 10.1038/srep41530] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 12/19/2016] [Indexed: 11/08/2022] Open
Abstract
Risk assessment in patients with acute coronary syndromes (ACS) is critical in order to provide adequate treatment. We performed a systematic meta-analysis to assess the predictive role of serum C-reactive protein (CRP) in patients with ST-segment elevation myocardial infarction (STEMI), treated with primary percutaneous coronary intervention (PPCI). We included 7 studies, out of 1,033 studies, with a total of 6,993 patients with STEMI undergoing PPCI, which were divided in the high or low CRP group, according to the validated cut-off values provided by the corresponding CRP assay. High CRP values were associated with increased in-hospital and follow-up all-cause mortality, in-hospital and follow-up major adverse cardiac events (MACE), and recurrent myocardial infarction (MI). The pre-procedural CRP predicted in-hospital target vessel revascularization (TVR), but was not associated with acute/subacute and follow-up in-stent restenosis (ISR), and follow-up TVR. Thus, pre-procedural serum CRP could be a valuable predictor of global cardiovascular risk, rather than a predictor of stent-related complications in patients with STEMI undergoing PPCI. This biomarker might have the potential to improve the management of these high-risk patients.
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Omland T, White HD. State of the Art: Blood Biomarkers for Risk Stratification in Patients with Stable Ischemic Heart Disease. Clin Chem 2016; 63:165-176. [PMID: 27815307 DOI: 10.1373/clinchem.2016.255190] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/28/2016] [Indexed: 01/26/2023]
Abstract
BACKGROUND Multiple circulating biomarkers have been associated with the incidence of cardiovascular events and proposed as potential tools for risk stratification in stable ischemic heart disease (IHD), yet current guidelines do not make any firm recommendations concerning the use of biomarkers for risk stratification in this setting. This state-of-the-art review provides an overview of biomarkers for risk stratification in stable IHD. CONTENT Circulating biomarkers associated with the risk of cardiovascular events in patients with stable IHD reflect different pathophysiological processes, including myocardial injury, myocardial stress and remodeling, metabolic status, vascular inflammation, and oxidative stress. Compared to the primary prevention setting, biomarkers reflecting end-organ damage and future risk of heart failure development and cardiovascular death may play more important roles in the stable IHD setting. Accordingly, biomarkers that reflect chronic, low-grade myocardial injury, and stress, i.e., high-sensitivity cardiac troponins and natriuretic peptides, provide graded and incremental prognostic information to conventional risk markers. In contrast, in stable IHD patients the prognostic value of traditional metabolic biomarkers, including serum lipids, is limited. Among several novel biomarkers, growth-differentiation factor-15 may provide the most robust prognostic information, whereas most inflammatory markers provide limited incremental prognostic information to risk factor models that include conventional risk factors, natriuretic peptides, and high-sensitivity troponins. SUMMARY Circulating biomarkers hold promise as useful tools for risk stratification in stable IHD, but their future incorporation into clinically useful risk scores will depend on prospective, rigorously performed clinical trials that document enhanced risk prediction.
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Affiliation(s)
- Torbjørn Omland
- Division of Medicine, Akershus University Hospital, Lørenskog, Norway and Center for Heart Failure Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway;
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
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Clinical relevance of high sensitivity C-reactive protein in cardiology. Medicina (B Aires) 2016; 52:1-10. [DOI: 10.1016/j.medici.2015.12.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/08/2015] [Accepted: 12/22/2015] [Indexed: 11/21/2022] Open
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10
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Pan HC, Sheu WHH, Lee WJ, Lee WL, Liao YC, Wang KY, Lee IT, Wang JS, Liang KW. Coronary severity score and C-reactive protein predict major adverse cardiovascular events in patients with stable coronary artery disease (from the Taichung CAD study). Clin Chim Acta 2015; 445:93-100. [DOI: 10.1016/j.cca.2015.03.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/27/2015] [Accepted: 03/17/2015] [Indexed: 11/16/2022]
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C-reactive protein prior to percutaneous coronary intervention: do we still need to check the lipid panel? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:129-30. [PMID: 24767312 DOI: 10.1016/j.carrev.2014.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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