C-reactive protein increase in acute myocardial infarction.
OBJECTIVE
Considering acute myocardial infarctions (AMI), data demonstrate that C-reactive protein (CRP) levels reflect the severity of myocardial damage and that high CRP level is associated with a worse outcome. This study evaluates the prognostic value of CRP and the determinants of its increase during AMI.


RESULTS
A retrospective observational study of 126 patients with a ST-segment elevation myocardial infarction (STEMI); 101 patients had reperfusion therapy (93 thrombolysis, 8 PTCA). Peak CRP (median: 3.5 mg/dl) was achieved the third day. A correlation existed between this peak and age (r = 0.1838; p = 0.0408). Diabetic patients not requiring insulin showed peaks double those of other patients (10.4 versus 6.1 mg/dl; p = 0.0165). The peak was higher in anterior infarctions (anterior: 8.4, lateral: 6.9, inferior: 6.4, posterior: 3.9 mg/dl; p = 0.0206) and for those showing a Q-wave (7.5 versus 3.9 mg/dl; p = 0.0020). It was correlated with the CK (r = 0.246; p = 0.0188) and troponin Ic (r = 0.242; p = 0.0224) peaks among thrombolysed patients. There was an increasing relationship between the occurrence of cardiac failure and the magnitude of the CRP peak. An inverse linear relationship existed between the ejection fraction of the left ventricle and the CRP peak (r = -0.4187; p = 0.0000). CRP peak was lower with statins (3.8 versus 7.0 mg/dl; p = 0.0446). Fibrates were only associated with lower CRP levels at admission (0.6 versus 0.9 mg/dl; p = 0.0010).


CONCLUSIONS
CRP is an indicator of the severity of STEMI. It is also an indicator for the occurrence of complications during hospitalization. The effect of statins and fibrates on CRP levels in AMI should be studied further.
Dedobbeleer
Chantal
C
Department of Cardiology, Erasme University Hospital, Brussels, Belgium. ddblch@skynet.be
Melot
Christian
C
Renard
Marc
M
D000208:Acute Disease; D000368:Aged; D002097:C-Reactive Protein / Q000187:drug effects; D002637:Chest Pain / Q000209:etiology; D005260:Female; D005340:Fibrinogen / Q000187:drug effects; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D019370:Observation; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents; D005340:Fibrinogen; D002097:C-Reactive Protein