Abstract 17301: C-Reactive Protein and Long-Term Risk of Death in Patients With Myocardial Infarction

Abstract

Introduction: The long-term prognostic value of C-reactive protein (CRP) in patients with myocardial infarction (MI) is unknown. Purpose: To assess the association between the first CRP measured during hospitalization and long-term mortality in patients with MI. Methods: Using Danish nationwide registries, we identified patients with a first diagnosis of MI from 2012 through 2020 who underwent a CRP measurement during index hospitalization. The primary outcome was death from any cause. The association between CRP levels and death was examined stratifying the patients into quartiles of CRP concentrations. Absolute and relative risks (RR) for death at days 0-30 and 31-365 were calculated through multivariable Cox regression with average treatment effect modeling. Models were standardized for demographic and clinical features, including high-sensitivity troponin (hsTn). Results: We included 36,021 patients with MI and a CRP measurement within 24 hours before or after the time of admission. Median age was 69.7 years and 35.2 % were women. Median CRP in the entire cohort was 4.9 mg/l, and quartile (Q) intervals were: Q1: <3 mg/l, Q2: 3 to <5 mg/l, Q3: 5 to <17 mg/l, and Q4: >=17 mg/l. CRP was significantly and nonlinearly associated with the primary outcome (p<0.001). At 0-30 days, 2694 patients had died, and another 2566 had died between days 31-365. Figure 1 shows the Kaplan Meier curves. The standardized absolute risk of death at both 0-30 and 31-365 days was lowest among patients in Q1 (0-30 days: 4.1%, 31-365 days: 4.8%) and highest among patients in Q4 (0-30 days: 12.1%, 31-365 days: 10.6%). The standardized RR of death compared with Q1 were: 0-30 days 1.01 (95% CI 0.84;1.71), 1.45 (1.26;1.63) and 2.96 (2.61;3.29) in Q2, Q3 and Q4 and at days 31-365, the RR were 1.18 (1.02;1.34), 1.61 (1.42;1.79) and 2.19 (1.95;2.42), respectively. Conclusion: In patients with MI, higher CRP levels were significantly associated with a higher risk of death, independently of hsTn concentrations.