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Clinical Investigations: CARDIOLOGY |

Level of High-Sensitivity C-Reactive Protein Is Predictive of 30-Day Outcomes in Patients With Acute Myocardial Infarction Undergoing Primary Coronary Intervention*

Hon-Kan Yip, MD; Chi-Ling Hang, MD; Chih-Yuan Fang, MD; Yuan-Kai Hsieh, MD; Cheng-Hsu Yang, MD; Wei-Chin Hung, MD; Chiung-Jen Wu, MD
Author and Funding Information

*From the Division of Cardiology, Chang Gung Memorial Hospital, Kaohsiung, Kaohsiung, Taiwan, ROC.

Correspondence to: Chiung-Jen Wu, MD, Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Kaohsiung, 123, Ta Pei Rd, Niao Sung Hsiang, Kaohsiung Hsien, 83301, Taiwan, ROC; e-mail: tang@adm.cgmh.org.tw



Chest. 2005;127(3):803-808. doi:10.1378/chest.127.3.803
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Background: C-reactive protein (CRP) has been well recognized as a strong independent predictor of short-term and long-term mortality after non–ST-segment elevation acute coronary syndromes. However, limited studies have been conducted correlating CRP levels within 6 h following the onset of ST-segment elevation (ST-se) acute myocardial infarction (AMI) to mortality. The purpose of this study was to evaluate the predictive value of CRP measured by high-sensitivity CRP assay (hsCRP) on 30-day clinical outcomes in patients with ST-se AMI of onset < 6 h undergoing primary percutaneous coronary intervention (PCI).

Methods and results: We conducted a prospective cohort study in 146 consecutive patients with ST-se AMI of onset < 6 h who were undergoing primary PCI. Blood samples for hsCRP were obtained in the catheterization laboratory before coronary angiography. Patients were classified into high (group 1: hsCRP > 2.37 mg/L, n = 73) and low (group 2: hsCRP ≤ 2.37 mg/L, n = 73) hsCRP groups according to the median value of hsCRP after AMI. Univariate analysis demonstrated that the 30-day composite major adverse cardiac events (MACE) [death, recurrent ischemia, and re-occlusion] were significantly higher in group 1 than in group 2 (23.3% vs 4.1%, p = 0.0008). Multiple stepwise logistic regression analysis demonstrated that high hsCRP (p = 0.001), cardiogenic shock (p = 0.0003), and low left ventricular ejection fraction (p = 0.032) were independent predictors of 30-day MACE.

Conclusions: Prospective evaluation of the hsCRP in ST-se AMI of onset < 6 h allows accurate risk stratification of individuals at risk of 30-day MACE after primary PCI.


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