Abstract
AimsIn STEMI patients, success of reperfusion of primary PCI predicts cardiac remodeling and clinical outcome. This success may depend on inflammation. We aimed to investigate the association between inflammation and reperfusion success, left ventricular function and long-term mortality in STEMI patients. MethodsIn 376 consecutive STEMI patients of the GIPS-III trial hs-CRP levels were measured at baseline, 2weeks, 7weeks and 4months post-PCI. Myocardial blush grade was used to determine success of myocardial reperfusion. In multivariate models sex, age, hs-CRP levels at baseline, NT-proBNP levels at baseline, ischemia time, heart rate, TIMI flow, and CK, CKMB and troponin AUC were included. Follow-up was complete until 4months. ResultsBaseline hs-CRP levels were 2.1mg/l (IQR 0.5–4.2mg/l). hs-CRP levels were associated with impaired reperfusion (OR 1.239, 95% CI 1.006–1.527) and remained higher compared to patients with normal reperfusion up to 2months after PCI (hs-CRP 1.9mg/l (IQR 0.9–3.7mg/l) versus 1.5mg/l (IQR 0.7–2.7mg/l), p=0.041). In multivariate analysis baseline hs-CRP levels remained independently associated with impaired reperfusion. In patients with impaired reperfusion, hs-CRP and NT-proBNP levels remained higher during 4months of follow-up. No correlation was observed between hs-CRP at baseline and left ventricular function at 4months. The number of events was small and we observed no differences in mortality. ConclusionIncreased hs-CRP levels at presentation are associated with impaired microvascular reperfusion after PCI in STEMI patients and remain higher until 2months follow-up.
Highlights
In patients with acute myocardial infarction (AMI) morbidity and mortality remains high despite advances in treatment like timely reperfusion of coronary stenosis by primary percutaneous coronary intervention (PCI)
This study investigated the temporal course of hs-C-reactive protein (CRP) levels in patients who presented with a first ST elevation myocardial infarction (STEMI) and treated with primary PCI
Higher high sensitivity C-reactive protein (hs-CRP) levels at presentation are associated with decreased reperfusion success and these levels remained higher in patients with impaired reperfusion for up to two months after PCI
Summary
In patients with acute myocardial infarction (AMI) morbidity and mortality remains high despite advances in treatment like timely reperfusion of coronary stenosis by primary percutaneous coronary intervention (PCI). After AMI left ventricular function is often impaired due to impaired left ventricular remodeling and results in heart failure (HF) [1,2,3]. AMI triggers a systemic acute-phase response, in which neutrophils and monocytes/ macrophages track to the infarcted region of the heart [2]. Epidemiological studies suggest that circulating concentrations of inflammatory markers, such as C-reactive protein (CRP) are associated with subsequent risk of atherosclerosis formation, coronary heart disease (CHD) and cardiac remodeling. In the setting of an AMI elevated CRP levels on admission are associated with impaired myocardial reperfusion as
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