High-Sensitivity C-Reactive Protein and Risk of Recurrent Vascular Events in Patients With Stroke Associated With Complex Aortic Atheroma.

Background: Complex aortic atheroma (CAA) is a high-risk source of ischemic stroke, yet predictors of recurrent vascular events in CAA-related stroke remain poorly defined. We evaluated the prognostic value of high-sensitivity C-reactive protein (hsCRP). Methods and Results: This single-center, prospective, observational registry enrolled consecutive patients with stroke within 1 week of onset. Transesophageal echocardiography (TEE) was not protocol-mandated but used at physician discretion, mainly for embolic-source evaluation. CAA was defined as any plaque ≥4 mm in thickness or a plaque with ulceration or mobile components on TEE. Patients were dichotomized by hsCRP at 3.0 mg/L. The primary outcome was 1-year major adverse cardiovascular events (MACE), including stroke, acute coronary syndrome, and vascular death. Among 1,214 patients, TEE was performed in 335; CAA was identified in 83 (24.8%). Seventy-six with hsCRP data were analyzed, with 1-year follow up obtained in 73 (96.1%). Over 1 year, 17 patients had at least 1 vascular event, yielding an event rate of 23.2%. The incidence of MACE was significantly higher in patients with hsCRP ≥3.0 mg/L than in those with hsCRP <3.0 mg/L (42.2% vs. 15.3%; log-rank P=0.010). In multivariable Cox analysis, hsCRP ≥3.0 mg/L independently predicted MACE (hazard ratio 4.68; 95% confidence interval 1.43-15.32). Conclusions: Elevated hsCRP is independently associated with an increased risk of MACE in CAA-related stroke. hsCRP may aid risk stratification and underscores the role of systemic inflammation in this high-risk subgroup.