What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Coronary slow flow (n=3231). Intervention: Elevated hs-CRP levels vs. Healthy controls with normal hs-CRP levels. Primary outcome: Difference in hs-CRP levels (mg/L) between CSF patients and controls (MD 1.95 mg/L, 95% CI 1.03 to 2.88, p=≤0.0001).

What does this research mean for the field?

Elevated high-sensitivity C-reactive protein (hs-CRP) levels are significantly associated with coronary slow flow, supporting its role as a state marker of the disease. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This meta-analysis examines the relationship between high-sensitivity C-reactive protein (hs-CRP) and coronary slow flow (CSF) to clarify conflicting findings.

February 27, 2026Open Access

The relationship between high-sensitivity C-reactive protein and coronary slow flow: a systematic review and meta-analysis

Key Result

Elevated hs-CRP levels were significantly associated with coronary slow flow, with a mean difference of 1.95 mg/L compared to controls (95% CI, 1.03 to 2.88; p≤0.0001).

Key Points

This meta-analysis examines the relationship between high-sensitivity C-reactive protein (hs-CRP) and coronary slow flow (CSF) to clarify conflicting findings.
Conducted a systematic review of studies measuring hs-CRP in CSF patients and controls.
Included 31 cross-sectional studies after a systematic search of 299 records.
Employed a random-effects meta-analysis to calculate standardized mean differences.
Assessed methodological quality using the Newcastle–Ottawa Scale.
Performed sensitivity analyses to ensure robustness of the findings.
Found a significant association between CSF and hs-CRP levels (MD: 1.95 mg/L; 95% CI, 1.03 to 2.88; p ≤ 0.0001).
Noted considerable heterogeneity among the included studies.
Confirmed that patients with CSF have significantly elevated hs-CRP levels compared to healthy controls.

Study Design

Type

Meta-Analysis (n=3,231)

Multicenter

Yes

Structured PICO

Are high-sensitivity C-reactive protein (hs-CRP) levels elevated in patients with coronary slow flow compared to healthy controls?

Population

3,231 participants (1,589 with coronary slow flow and 1,642 healthy controls) pooled from 31 cross-sectional studies. Average age ranged from 36 to 72 years old.

Intervention

Presence of coronary slow flow (CSF)

Comparator

Healthy controls

Outcome

High-sensitivity C-reactive protein (hs-CRP) levelssurrogate

Patients with coronary slow flow exhibit significantly elevated hs-CRP levels compared to healthy controls, supporting the role of low-grade peripheral inflammation in the pathogenesis of the disease.

Main Result

Effect estimate: MD 1.95 mg/L (95% CI 1.03 to 2.88)

Absolute Event Rate: 1.95% vs 0%

p-value: p=≤0.0001

Limitations

Observational and cross-sectional study designs limit causal inference.
High heterogeneity among included studies (I2 = 96%).
Inconsistent adjustment for confounders such as smoking, diabetes, and hypertension.
Presence of publication bias indicated by Egger's test (p < 0.0001).
Variations in exclusion criteria across studies may affect results.
Trim and Fill adjustment less reliable due to high heterogeneity.

Abstract

Despite the unknown mechanisms of coronary slow flow (CSF), several studies have investigated the role of inflammation in CSF pathogenesis and evaluated the hs-CRP levels in these patients. Our meta-analysis aims to resolve the controversy in the results and draw a conclusion. All studies measuring hs-CRP in patients with CSF and controls were included after a systematic search. A random-effects meta-analysis was employed to calculate standardized mean differences, considering heterogeneity among the studies. The methodological quality of the included studies was assessed using the Newcastle–Ottawa Scale (NOS). Out of the 299 records, 31 cross-sectional studies were included in the systematic review. The meta-analysis of these eligible cross-sectional studies revealed a significant association between CSF and hs-CRP (MD: 1.95 mg/L; 95% CI, 1.03 to 2.88; p ≤ 0.0001). The heterogeneity was considerable among studies. Additionally, sensitivity analyses indicated that the meta-analysis models were robust. This meta-analysis suggests that patients with CSF exhibit significantly elevated hs-CRP levels compared to healthy controls, supporting the role of hs-CRP as a state marker of the disease. CRD42023359516

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