Admission C-reactive protein levels and 30-day mortality in patients with acute myocardial infarction.
BACKGROUND
Elevated C-reactive protein levels are associated with an increased risk of subsequent cardiovascular events in patients with unstable angina. However, limited information is available concerning the value of C-reactive protein levels in patients with acute myocardial infarction.


METHODS
We prospectively studied 448 consecutive patients (mean [+/- SD] age, 60 +/- 12 years) with acute myocardial infarction. Serum C-reactive protein levels were measured within 12 to 24 hours of symptom onset, and divided into tertiles. Infarct size was determined by echocardiographic examination that was performed on day 2 or 3. Patients were followed for 30 days for mortality and subsequent cardiac events.


RESULTS
At 30 days, 4 deaths (3%) occurred in patients in the lowest C-reactive protein tertile, 15 (10%) in patients in the middle tertile (P = 0.02 vs. the lowest tertile), and 33 (22%) in patients in the highest tertile (P <0.001 vs. the lowest tertile). In a multivariate analysis, C-reactive protein in the upper tertile was associated with 30-day mortality (relative risk = 3.0; 95% confidence interval [CI]: 1.3 to 7.2; P = 0.01) and the development of heart failure (odds ratio = 2.6; 95% CI: 1.5 to 4.6; P = 0.0006). C-reactive protein levels were not associated with the development of postinfarction angina, recurrent myocardial infarction, or the need for revascularization.


CONCLUSIONS
Plasma C-reactive protein level obtained within 12 to 24 hours of symptom onset is an independent marker of 30-day mortality and the development of heart failure in patients with acute myocardial infarction. These findings suggest that C-reactive protein levels may be related to inflammatory processes associated with infarct expansion and postinfarction ventricular remodeling.
Suleiman
Mahmoud
M
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport Faculty of Medicine, Haifa,. Israel.
Aronson
Doron
D
Reisner
Shimon A
SA
Kapeliovich
Michael R
MR
Markiewicz
Walter
W
Levy
Yishai
Y
Hammerman
Haim
H
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000378:metabolism / Q000401:mortality / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism* / Q000401:mortality / Q000628:therapy*; D010343:Patient Admission; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D013223:Statistics as Topic; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine; D003402:Creatine Kinase