Predictive value of basal C-reactive protein levels for myocardial salvage in patients with acute myocardial infarction is dependent on the type of reperfusion treatment.
OBJECTIVE
To evaluate whether C-reactive protein (CRP) levels on admission are predictive of myocardial salvage achieved with different reperfusion strategies in patients with acute myocardial infarction (AMI).


RESULTS
Patients with AMI treated with stenting plus abciximab (n=125) and thrombolysis alone (n=54) or with abciximab (n=71) were prospectively studied. CRP levels were measured by a high sensitivity assay. The threshold of the upper quartile (12 mg/l) was used to divide patients into two groups: 60 patients with high CRP (>12 mg/l) and 190 patients with low CRP (< or =12 mg/l). Myocardial salvage was measured by technetium (Tc)-99(m)sestamibi scintigraphy. Patients in the high CRP group had a significantly lower salvage index (0.35+/-0.42 vs 0.48+/-0.34, p=0.01) and higher 18-month mortality (11.7 vs 3.2%, p=0.03) compared to those in the low CRP group. While basal CRP was not related to myocardial salvage in patients treated with stenting plus abciximab (p=0.89) or thrombolysis plus abciximab (p=0.43), a high CRP on admission was associated with a significantly lower salvage index (0.09+/-0.48 vs 0.42+/-0.37 in the low CRP group, p=0.006) among patients treated with thrombolysis alone.


CONCLUSIONS
CRP levels on admission may predict the efficacy of reperfusion in patients with AMI. The predictive ability is dependent on the form of reperfusion therapy.
Dibra
Alban
A
Deutsches Herzzentrum, Technische Universität München, Munich, Germany.
Mehilli
Julinda
J
Schwaiger
Markus
M
Schühlen
Helmut
H
Bollwein
Hildegard
H
Braun
Siegmund
S
Neverve
Jodi
J
Schömig
Albert
A
Kastrati
Adnan
A
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000378:metabolism*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D016879:Salvage Therapy / Q000379:methods; D015607:Stents; D016019:Survival Analysis; D017256:Technetium Tc 99m Sestamibi; D015912:Thrombolytic Therapy / Q000379:methods*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019275:Radiopharmaceuticals; D002097:C-Reactive Protein; D017256:Technetium Tc 99m Sestamibi; D000077284:Abciximab