Abstract

Background: High sensitivity CRP (hs-CRP) has attracted intense interest in risk assessment. We aimed to explore its prognostic value in patients with acute myocardial infarction (AMI).Methods and Results: We enrolled 4,504 consecutive AMI patients in this prospective cohort study. The associations between hs-CRP levels with the incidence of in-hospital HF was evaluated by logistic regression analysis. The association between hs-CRP levels and the cumulative incidence of HF after hospitalization were evaluated by Fine-Gray proportional sub-distribution hazards models, accounting for death without HF as competing risk. Cox proportional hazards regression models were constructed to estimate the association between hs-CRP levels and the risk of all-cause mortality. Over a median follow-up of 1 year, 1,112 (24.7%) patients developed in-hospital HF, 571 (18.9%) patients developed HF post-discharge and 262 (8.2%) patients died. In the fully adjusted model, the risk of in-hospital heart failure (HF) [95% confidence intervals (CI)] among those patients with hs-CRP values in quartile 3 (Q3) and Q4 were 1.36 (1.05–1.77) and 1.41 (1.07–1.85) times as high as the risk among patients in Q1 (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.33 (1.00–1.76) and 1.80 times (1.37–2.36) as high as the risk of HF post-discharge compared with patients in Q1 respectively (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.74 (1.08–2.82) and 2.42 times (1.52–3.87) as high as the risk of death compared with patients in Q1 respectively (p trend < 0.001).Conclusions: Hs-CRP was found to be associated with the incidence of in-hospital HF, HF post-discharge and all-cause mortality in patients with AMI.

Highlights

  • C-reactive protein (CRP), an acute-phase protein reflecting the early inflammation response, has emerged as a simple tool for risk assessment for coronary events in general population [1,2,3]

  • Most of the recent studies were focused on mortality, recurrent myocardial infarction or late development of heart failure (HF) and most of them were limited by relatively small sample sizes or only conducted in stable myocardial infarction survivors, ST-segment elevation myocardial infarction (STEMI) or non–ST-segment elevation myocardial infarction patients (NSTEMI) patients alone

  • Few of the above studies focused on in-hospital HF and what is noteworthy is that high sensitivity CRP detected by an ultrasensitive automated enzyme immunoassay has been shown to be a better indicator of outcomes than CRP levels measured through traditional assays [13]

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Summary

Introduction

C-reactive protein (CRP), an acute-phase protein reflecting the early inflammation response, has emerged as a simple tool for risk assessment for coronary events in general population [1,2,3]. In this setting, CRP levels might reflect local inflammation process in the coronary artery or an intensification of focal inflammatory processes that destabilize vulnerable plaques [4]. We aimed to assess the prognostic value of hs-CRP on clinical outcomes including in-hospital HF and HF post-discharge as well as all-cause mortality and recurrent myocardial infarction in patients with acute myocardial infarction (AMI). We aimed to explore its prognostic value in patients with acute myocardial infarction (AMI)

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