Prognostic value of serum high-sensitivity C-reactive protein in patients with acute ST-segment elevated myocardial infarction

Abstract

Objective To assess the predictive value of early determination of high-sensitivity C-reactive protein (hs-CRP) levels at admission in patients with acute ST-elevated myocardial infarction (STEM1). Major ad-verse cardiovascular events (MACE) were angina,re-infarction, cardiac failure and cardiac arrest. Method One hundred and eighty-nine patients with acute STEMI were enrolled in this study. Before intetventional therapy, a peripheral blood sample was collected from the fasting patients within 24 hours after the onset of symptoms for the measurement of serum hs-CRP, white blood cell count (WBCs), creatine kinase (CK), MB iso-enzyme of creatine kinase (CK-MB), blood lipid and blood glucose separately. Meanwhile, color echocardiogram was performed. Pa-tients were divided into two groups according to the serum level of hs-CRP, hs-CRP ＞ 4 mg/L group and hs-CRP= 4 mg/L group. And patients were monitored for the occurrence of MACE. Univariate and multivariate Cox's pro-portional hazard regression analyses were performed to determine the relationship between various potential risk factors alone or in combination and MACE as well as death. Survival curves were plotted by using the Kaplan-Meier method, and the log-rank test and Breslow test were used to compare the survival curves. Results The pa-tients with acute STEM1 were followed-up for a mean of (271.1= 136.7) days doe MACE. The difference in inci-dence of MACE between high and low hs-CRP level groups was obvious (75% vs. 25%, P ＜ 0.01). The meanserum levels of WBCs, CK, and CK-MB in the high hs-CRP level group were higher than those of the low hs-CRPlevel group(P= 0.002,0.039 and 0.049, respectively). The highest serum level of hs-CRP was found in de-ceased patient cohort. The serum level of hs-CRP was higher in patients with MACE compared with those withoutMACE (P ＜ 0.01). Kaplan-Meier plots for overall survivals and MACE-free survivals showed a significant distinctbetween high and low hs-CRP level groups (P= 0.0042 and 0.0062 by log-rank test, respectively). The hs-CRPserum levels were independent risk predictors of MACE (RR= 1.919, P ＜0.05) and death (RR= 3.067, P ＜ 0.05). Patients with high hs-CRP levels and age P 65 years were at higher risk of MACE occurrence (RR=2.547, P ＜ 0.01) and death (RR= 4.140, P ＜ 0.01). Conclusions The serum levels of hs-CRP at admis-sion were independent risk predictors of MACE and death in patients with acute STEMI during the period of follow-up. The evaluation of hs-CRP and age may provide an approach to screening the high-risk patients. Key words: High-sensitivity C-reactive protein; ST-segment elevation myocardial infarction; Angina; Rein-farction; Cardia failure; Cardiac death; Follow up; Prognosis