High-Sensitivity C-reactive Protein as a Predictive Biomarker of Coronary Artery Disease Severity: A Cross-Sectional Study in Bangladesh

Background Bangladesh bears a substantial burden of advanced coronary artery disease (CAD), yet affordable biomarkers that can help predict angiographic disease severity before invasive assessment remain limited. High-sensitivity C-reactive protein (hs-CRP), a marker of vascular inflammation, has been linked to atherosclerosis, but its utility in predicting multivessel disease in resource-limited settings remains uncertain. The primary objective of this study was to compare hs-CRP levels between patients with angiographically confirmed CAD and those without CAD. The secondary objective was to evaluate the association and predictive utility of hs-CRP with the angiographic severity of CAD, with particular emphasis on multivessel involvement among patients undergoing coronary angiography. Methods This cross-sectional study included 300 adult participants undergoing coronary angiography, comprising 150 angiographically confirmed CAD cases and 150 controls without CAD. Participants were enrolled purposively from the Department of Cardiology of Bangladesh Medical University (BMU) and Dhaka National Medical Institute Hospital (DNMIH), Dhaka, Bangladesh, from January 2024 to December 2024. CAD severity was categorised as single-vessel, double-vessel, and triple-vessel disease according to the number of major coronary arteries involved. Laboratory investigations, including fasting lipid profile, glycosylated haemoglobin (HbA1c), and hs-CRP, were measured using standardised automated laboratory platforms. Ethical approval was obtained from the Institutional Ethical Review Board of Dhaka National Medical College, Dhaka. Results Most participants in both groups were aged 41-60 years, and the median age was similar between cases and controls (52 (19-68) years vs. 52 (28-70) years, p-value: 0.569). Male participants were significantly more frequent in the case group than in the control group (114 (76.0%) vs. 95 (63.3%), p-value: 0.017). hs-CRP levels were significantly higher among CAD cases than controls (p value: <0.001) and increased progressively with angiographic severity. A moderate positive correlation was observed between hs-CRP and the number of diseased vessels (rs=0.449, p value:<0.001). Receiver operating characteristic (ROC) analysis showed moderate ability of hs-CRP to discriminate multivessel CAD (area under the curve (AUC)=0.729, 95% CI: 0.651-0.808). A cut-off value of ≥22.89 mg/L provided 95.1% specificity and 97.0% positive predictive value. Triple-vessel disease was present in 68 (45.3%) cases, while hypertension and diabetes were the most common comorbidities. Conclusion Elevated hs-CRP was significantly associated with both the presence and angiographic severity of CAD. It may serve as a useful adjunctive biomarker for identifying advanced coronary disease in resource-limited settings.