Very Early C-Reactive Protein Levels after Acute Myocardial Infarction Predict Early Outcome and Late Prognosis


Objectives: C-reactive protein (CRP) blood levels are associated with atherosclerosis and increased incidence of coronary events. Aim: To evaluate the utility for risk stratification of very early blood CRP levels, during the first 6 hours after the onset of chest pain, in patients with acute myocardial infarction (AMI). Methods: 118 patients with AMI, 88 men, age 63.3 ± 8 yrs, were evaluated, and CRP was assessed within the first 6 hours after the onset of chest pains. Results: CRP level in all patients was 15.7 ± 14.1 mg/L. Its level increased with higher Killip class, 11.2 ± 5 mg/L in class 1, and 62 ± 7 mg/L in class 4 (p < 0.01), and with lower left ventricular ejection fraction (EF), 32.3 ± 10 mg/L with EF < 30% and 9 ± 4 mg/L with EF > 40% (p < 0.01). Higher CRP values were found in patients with 3 vessel coronary artery diseases 20.7 ± 8 mg/L, vs. 8.7 ± 4 mg/L with 2 and 1 vessel disease (p < 0.05). Patients with in-hospital complications had higher CRP, 33.7 ± 10 mg/L vs. 12.1 ± 5 mg/L in those without (p < 0.001). Eight patients died at one-year follow-up. The CRP levels on admission in patients who died during the first year of follow-up, 45.2 ± 7.7 mg/L were higher than those in the survivors without adverse events, 11.6 ± 5 mg/L (p < 0.001). Admission CRP level in patients re-admitted with unstable angina, re-infarction or those who had coronary bypass surgery was similar to that in those who were not. Conclusions: Very early blood CRP levels in patients with AMI predict functional capacity, systolic left ventricular function, extent of coronary artery disease, early and short term complications and 1-year mortality but not recurrent myocardial ischemic events.

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Sharif, D. , Hammoud, M. , Sharif-Rasslan, A. , Abinader, E. and Odeh, M. (2015) Very Early C-Reactive Protein Levels after Acute Myocardial Infarction Predict Early Outcome and Late Prognosis. International Journal of Clinical Medicine, 6, 547-553. doi: 10.4236/ijcm.2015.68073.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Ridker, P.M., Cushman, M., Stampfer, M.J., Tracy, R.P. and Hennekens, C.H. (1997) Inflammation, Aspirin and the Risk of Cardiovascular Disease in Apparently Healthy Men. The New England Journal of Medicine, 336, 973-979.
[2] Ridker, P.M., Buring, J.E., Shih, J. and Hennekens, C.H. (1998) Prospective Study of C-Reactive Protein and the Risk of Future Cardiovascular Events among Apparently Healthy Women. Circulation, 98, 731-733.
[3] Liuzzo, G., Biasucci, L.M., Gallimore, J.R., et al. (1994) The Prognostic Value of C-Reactive Protein and Serum Amyloid A Protein in Severe Unstable Angina. The New England Journal of Medicine, 331, 417-424.
[4] Morrow, D.A., Rifai, N., Antman, E.M., et al. (1998) C-Reactive Protein Is a Potent Predictor of Mortality Independently and in Combination with Troponin T in Acute Coronary Syndromes: A TIMI 11A Substudy. Journal of the American College of Cardiology, 31, 1460-1465.
[5] Ferreiros, E.R., Boissonnet, C.P., Pizzaro, R., et al. (1999) Independent Prognostic Value of Elevated C-Reactive Protein in Unstable Angina. Circulation, 100, 1958-1963.
[6] Biasucci, L.M., Liuzzo, G., Grillo, R.L., et al. (1999) Elevated Levels of C-Reactive Protein at Discharge in Patients with Unstable Angina Predict Recurrent Instability. Circulation, 99, 855-860.
[7] Pietila, K.O., Harmoineni, A.P., Jokiniittyf, J. and Pasternack, A.I. (1996) Serum C-Reactive Protein Concentration in Acute Myocardial Infarction and Its Relationship to Mortality during 24 Months of Follow-Up in Patients under Thrombolytic Treatment. European Heart Journal, 17, 1345-1349.
[8] Sabatine, M.S., Morrow, D.A., Cannon, C.P., et al. (2002) Relationship between Baseline White Blood Cell Count and Degree of Coronary Artery Disease and Mortality in Patients with Acute Coronary Syndromes: TACTICS TIMI 18 (Treat Angina with Agrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy-Thrombolysis in Myocardial Infarction Trial) Substudy. Journal of the American College of Cardiology, 40, 1761-1768.
[9] Barron, H.V., Cannon, C.P., Murphy, S.A., Braunwald, E. and Gibson, M. (2000) Association between White Blood Cell Count, Epicardial Blood Flow, Myocardial Perfusion and Clinical Outcomesin the Setting of Cute Myocardial Infarction. A Thrombolysis in Myocardial Infarction Substudy. Circulation, 102, 2329-2334.
[10] Timmer, J.R., Ottervanger, J.P., Hoorntje, J.C., et al. (2005) Prognostic Value of Erythrocyte Sedimentation Rate in ST Segment Elevation Myocardial Infarction: Interaction with Hyperglycaemia. Journal of Internal Medicine, 257, 423-429.
[11] Fatih Ozlu, M., Sen, N., Fatih Karakas, M., Turak, O., Ozcan, F., Kanat, S., et al. (2012) Erythrocyte Sedimentation Rate in Acute Myocardial Infarction as a Predictor of Poor Prognosis and Impaired Reperfusion. Medicinski Glasnik, 9, 189-197.
[12] Sánchez, P.L., Rodríguez, M.V., Villacorta, E., Albarrán, C., Cruz, I., Moreiras, J.M., et al. (2006) Kinetics of C-Reactive Protein Release in Different Forms of Acute Coronary Syndrome. Revista Española de Cardiología, 59, 441-447.
[13] Dimitrijevic, O., Stojcevski, B.D., Ignjatovic, S. and Singh, N.M. (2006) Serial Measurements of C-Reactive Protein after Acute Myocardial Infarction in Predicting One-Year Outcome. International Heart Journal, 47, 833-842.
[14] Berton, G., Cordiano, R., Palmieri, R., Pianca, S., Pagliara, V. and Palatini, P. (2003) C-Reactive Protein in Acute Myocardial Infarction: Association with Heart Failure. American Heart Journal, 145, 1094-1101.
[15] Sano, T., Tanaka, A., Namba, M., Nishibori, Y., Nishida, Y., Kawarabayashi, T., et al. (2003) C-Reactive Protein and Lesion Morphology in Patients with Acute Myocardial Infarction. Circulation, 108, 282-285.
[16] Khno, T., Anzai, T., Naito, K., Ohno, Y., Kaneko, H., Li, H.-C., et al. (2007) Impact of Serum C-Reactive Protein Elevation on the Left Ventricular Spherical Change and the Development of Mitral Regurgitation after Anterior Acute Myocardial Infarction. Cardiology, 107, 386-394.
[17] Niccoli, G., Biasucci, L.M., Biscione, C., Fusco, B., Porto, I., Leone, A.M., et al. (2008) Independent Prognostic Value of C-Reactive Protein and Coronary Artery Disease Extent in Patients Affected by Unstable Angina. Atherosclerosis, 196, 779-785.
[18] Hackel, D.B., Reimer, K.A., Ideker, R.E., Mikat, E.M., Hartwell, T.D., Parker, C.B., et al. (1984) Comparison of Enzymatic and Anatomic Estimates of Myocardial Infarct Size in Man. Circulation, 70, 824-835.
[19] Turer, A.T., Mahaffey, K.W., Gallup, D., Weaver, W.D., Christenson, R.H., Every, N.R. and Ohman, E.M. (2005) Enzyme Estimates of Infarct Size Correlate with Functional and Clinical Outcomes in the Setting of ST-Segment Elevation Myocardial Infarction. Current Controlled Trials in Cardiovascular Medicine, 6, 12.
[20] Licka, M., Zimmermann, R. and Zehelein, J. (2002) Troponin T Concentrations 72 Hours after Myocardial Infarction as a Serological Estimate of Infarct Size. Heart, 87, 520-524.
[21] Steen, H., Giannitsis, E., Futterer, S., Merten, C., Juenger, C. and Katus, H.A. (2006) Cardiac Troponin T at 96 Hours after Acute Myocardial Infarction Correlates with Infarct Size and Cardiac Function. Journal of the American College of Cardiology, 48, 2192-2194.
[22] Giannitsis, E., Steen, H., Kurz, K., Ivandic, B., Simon, A.C., Futterer, S., et al. (2008) Cardiac Magnetic Resonance Imaging Study for Quantification of Infarct Size Comparing Directly Serial versus Single Time-Point Measurements of Cardiac Troponin T. Journal of the American College of Cardiology, 51, 307-314.
[23] Chia, S., Senatore, F., Raffel, O.C., Lee, H., Wackers, F.J.T. and Jang, I.-K. (2008) Utility of Cardiac Biomarkers in Predicting Infarct Size, Left Ventricular Function, and Clinical Outcome after Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. JACC: Cardiovascular Interventions, 1, 415-423.

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