title: C-reactive protein as a predictor of infarct expansion and cardiac rupture after a first Q-wave acute myocardial infarction.
abstract: BACKGROUND
  Pump failure after acute myocardial infarction (AMI) can be predicted by several indices that estimate infarct size. However, there are few indices that predict infarct expansion and cardiac rupture. We focused on the prognostic significance of serum C-reactive protein (CRP) after AMI.
  
  
  RESULTS
  Serum CRP levels were measured every 24 hours in 220 patients with a first Q-wave AMI. In-hospital complications, predischarge left ventriculographic findings, and long-term prognosis were assessed in relation to peak CRP levels. Peak levels of both CRP and creatine kinase (CK) were higher in patients with pump failure than in those without pump failure. In patients with cardiac rupture, peak CRP levels were higher than in those without rupture (P=.001); peak CK levels were not predictive. Higher CRP levels were found in patients with left ventricular aneurysm (P=.001 versus those without), aggravated heart failure (P=.03 versus those without), and cardiac death (P<.0001 versus survivors) during the first year after AMI. Multivariate analysis confirmed that an elevation of the peak CRP level > or = 20 mg/dL was an independent predictor of cardiac rupture (relative risk, 4.72; P=.004), left ventricular aneurysmal formation (relative risk, 2.11; P=.03), and 1-year cardiac death (relative risk, 3.44; P<.0001).
  
  
  CONCLUSIONS
  Cardiac rupture, left ventricular aneurysmal formation, and 1-year cardiac death were associated with an elevation of serum CRP early after AMI, suggesting that elevation of CRP levels after AMI may predict infarct expansion.
authors.affiliation: Department of Medicine, Keio University School of Medicine, Tokyo, Japan. tanzai@vapop.ucsd.edu
authors.forename: T
authors.initials: T
authors.lastname: Anzai
authors.forename: T
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: H
authors.initials: H
authors.lastname: Shiraki
authors.forename: Y
authors.initials: Y
authors.lastname: Asakura
authors.forename: M
authors.initials: M
authors.lastname: Akaishi
authors.forename: H
authors.initials: H
authors.lastname: Mitamura
authors.forename: S
authors.initials: S
authors.lastname: Ogawa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D017023:Coronary Angiography; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006321:Heart / Q000000981:diagnostic imaging*; D006322:Heart Aneurysm / Q000209:etiology; D006341:Heart Rupture / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D011379:Prognosis; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein; D003402:Creatine Kinase