Raised C-reactive protein following primary PCI is associated with adverse short and long-term clinical outcome - analysis from a real world STEMI population

Abstract

Purpose: Although the impact of inflammation on short-term clinical outcomes following Primary PCI (PPCI) in patients with STEMI is well described, there is little literature examining longer-term outcomes. This retrospective study assesses the association between C-Reactive Protein (CRP) levels following PPCI and clinical outcome in patients at our tertiary referral centre. Methods: All patients accepted for PPCI between September 2009 and November 2011 were eligible for inclusion. Patient data were obtained from Cardiac Services Database System (Phillips CVIS), and mortality data from the Summary Care Record (SCR) database. Patient characteristics and clinical outcomes were compared according to CRP groups: low (≤10 mg/L), intermediate (10-50 mg/L), and high (>50 mg/L). Continuous variables were compared using one-way ANOVA. Categorical variables were compared using the chi-squared test. A p-value of <0.05 was taken to indicate statistical significance. Results: 1299 of 1877 eligible patients had a recorded CRP and were analysed. Patients in the high CRP group were more likely to be female (32.6% vs. 23.1%, p 0.024) and older (mean age 67.3±14.1 vs. 63.8±12.5 years, p 0.011). Other characteristics were similar across groups (hypertension, diabetes mellitus, previous MI, CABG). 30-day mortality was significantly higher in the high group compared to the low group (1.3% vs. 16.7%, p <0.0001), as was overall mortality (hazard ratio 1.8, 95% CI 1.3-2.8) during a mean follow-up period of 2.1 years (Figure 1). ![Figure][1] Figure 1. Kaplan-Meier Survival Curve Conclusions: Our large-cohort retrospective study suggests that elevated CRP at PPCI is associated with significantly higher long-term mortality. Further work is required on strategies to modify inflammatory response following STEMI and improve clinical outcomes following PPCI. [1]: pending:yes