Association between Electrocardiographic Pattern and Level of C-Reactive Protein in Patients with First Anterior Wall Acute Myocardial Infarction

Abstract

Background: Studies of prognostic markers after first anterior wall acute myocardial infarction (AMI) have reported an association between persistent ST segment elevation on the electrocardiogram (ECG) and increased levels of C-reactive protein (CRP) and worse outcome. The aim of the present study was to determine the nature of the relationship between these two factors. Methods: Twenty-three consecutive patients admitted with AMI underwent 12-lead ECG on days 1, 2, 3 and 7 and were classified into two groups according to the findings on each day’s recording: pattern A – isoelectric ST segment, or pattern B – ST segment elevation with or without a negative T wave. Serum CRP levels measured on the same days were also compared between the groups. Results: The number of patients classified as pattern A increased over time, from 8 on day 1 after AMI to 11 on day 2, 12 on day 3 and 14 on day 7, with a corresponding decrease in pattern B patients. Most of the patients with pattern B on day 1 showed a persistent pattern on day 7. For each day studied, the pattern A and pattern B patients showed a statistically significant difference in serum CRP levels on the second and third days after AMI, respectively. Values for the day 7 groups were: 3.1 ± 3.4 versus 9.6 ± 3.8 mg% (p = 0.001) (day 2) and 3.1 ± 1.2 versus 7.9 ± 3.6 mg% (p = 0.0005) (day 3). Conclusion: There was a significant association between high CRP levels on the second and third day following first AMI and ECG pattern B (ST elevation). This conclusion strengthens our earlier findings that pattern B is predictive of poor outcome in this patient population.