C-reactive protein on admission and the success of thrombolytic therapy with streptokinase: is there any relation?
BACKGROUND
Recent evidence has demonstrated that inflammation plays a major role in the initiation and progression of atheroma plaques. C-reactive protein (CRP) is shown to have prognostic significance in acute coronary syndromes. We investigated the influence of CRP levels before thrombolytic therapy on infarct-related artery (IRA) patency and the degree of residual stenosis.


METHODS
45 consecutive patients with a first attack of acute myocardial infarction (MI) who underwent streptokinase therapy and subsequently coronary angiography were enrolled into the study. Patients were divided into 2 groups according to the level of CRP on admission.


RESULTS
Serum CRP levels were > or =0.5 mg/dL in 26 patients (Group-I) and <0.5 mg/dL in 19 patients (Group-II). The patency of IRA (TIMI-2 and 3) evaluated at 90th minute after the initiation of thrombolytic therapy was similar between the two groups (62% vs. 68%, p>0.05). However, the presence of TIMI-3 flow was significantly lower and TIMI-2 flow was higher in Group-I as compared to Group-II (12% vs. 53%, p=0.003 and 50% vs. 16%, p=0.018 respectively). Additionally, among patients with patent IRA, the degree of residual stenosis was significantly higher in Group-I (80 +/- 14% vs. 68 +/- 15%, p=0.032).


CONCLUSIONS
High serum CRP levels on admission in patients within 6 hours after the start of acute ST-segment elevation MI are associated with lower TIMI flow grades and higher residual stenosis of IRA after intravenous streptokinase. Our observations imply that patients with higher CRP levels on admission require closer follow-up during and after acute MI.
Department of Cardiology, Gulhane Military Medical Academy, 06018 Ankara, Turkey. dramasyali@yahoo.com
Basri
B
Amasyali
Sedat
S
Kose
Ayhan
A
Kilic
Atila
A
Iyisoy
Cem
C
Barcin
Hurkan
H
Kursaklioglu
Nadir
N
Barindik
Serhat
S
Tokgoz
Ersoy
E
Isik
Ertan
E
Demirtas
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology / Q000628:therapy; D012039:Regional Blood Flow; D015607:Stents; D013300:Streptokinase / Q000627:therapeutic use*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D002097:C-Reactive Protein; D013300:Streptokinase