Elevated C-reactive protein levels are associated with myocardial ischemia early in the course of non-ST elevation coronary syndromes

Abstract

Background High plasma levels of C-reactive protein (CRP) are associated with shortor long-term ischemic complications in patients with unstable coronary artery disease. However, a possible direct relationship of plasma CRP with spontaneous myocardial &hernia early I” the course of non ST elevation acute coronary syndromes (NSTACS) was not thoroughly investigated. MethodsTo evaluate this issue 172 consecutive patients with NSTACS with no elevated plasma cardiac troponin T levels upon admission (cTnT-zO.1 yojdl) who underwent a 24 hour continuous IBlead electrocardiographic (ECG) monitoring were studied. The associatlon of plasma CRP levels upon admission with either the incidence or duration of the recorded myocardial ischemla (ST-segment shifts) was evaluated. Patients divided into three groups according to the tertiles of CRP values upon admission. Results During 3,696 hours of contmuous 12.lead ECG monitoring, 169 ST-segment shifts were recorded in 48 patients with a mean number of 3.5k2.0 shifts per patient and a mean duration of 29.6i23.6 min per episode, corresponding to a total duration of 124.4k143.6 mm per patlent. There was a significant gradual increased risk for either the incidence (p<O.OOl) or the total duration of ST-segment shifts with increasing of CRP tertiles (p=O.Ol). MultivarIate analysis showed that CRP tertiles were independently and positively related to the occurrence of ST-segment shifts. Conclusions High plasma levels of CRP may be associated with a higher incidence of myocardial tschemia early III the tours.? of NSTACS, suggesting a direct relationship of inflammation in this process.