title: Time-dependent changes of hs-CRP serum concentration in patients with non-ST elevation acute coronary syndrome.
abstract: BACKGROUND
  Atherosclerosis is typically associated with a low-grade vascular inflammation that can be measured with the highly sensitive C-reactive protein (hs-CRP) assay. Actually, acute coronary syndromes are thought to result from plaque rupture which is induced by the inflammatory process in the atherosclerotic tissue. Therefore, it is interesting to discuss the value of follow-up measurements of hs-CRP in patients with coronary artery disease (CAD).
  
  
  METHODS
  The hs-CRP concentration of 133 patients consecutively admitted with an acute coronary syndrome (ACS) was measured on admission and after 6 months. The final assessment after 3 years was structured by questionnaire.
  
  
  RESULTS
  17 cardiac events occurred within 6 months, 30 during the following 3 years. The hs-CRP levels (median +/- SEM) decreased significantly (p < 0.001) from baseline (3.9 +/- 1.3 mg/l) to follow-up (2.9 +/- 0.9 mg/l). Subdivision according to cardiac events during the first observation period confirmed this decrease in patients without events (baseline: 3.9 +/- 1.5 mg/l, follow-up: 2.9 +/- 0.9 mg/l; p < 0.001), whereas patients with events showed a persistent elevation (baseline: 3.8 +/- 0.9 mg/l, follow-up: 4.1 +/- 1.0 mg/l; p = 0.426). Patients who developed a further event during the 6-month period showed hs-CRP levels at follow-up that were > 60% of the initial level. Interestingly, 80% of the events within the following 3 years occurred in patients with an hs-CRP level above this discriminator. With a follow-up hs-CRP value above this discriminator the relative risk of suffering an event was 3.4 (95% confidence interval 1.27-8.9; p < 0.05).
  
  
  CONCLUSIONS
  Patients with a non-ST elevation ACS who showed no event within 6 months are characterized by a decrease in hs-CRP levels from baseline to follow-up. Most events in the observation period of 3 years occurred in patients with follow-up hs-CRP levels > 60% of the initial level. Therefore, it was hypothesized that a repeated measurement of hs-CRP levels in CAD patients could help to discriminate those at high risk of further events.
authors.affiliation: Department of Internal Medicine, Borromäus Hospital, Leer, Germany. jahn@borro-leer.de
authors.forename: Jürgen
authors.initials: J
authors.lastname: Jahn
authors.forename: Inke
authors.initials: I
authors.lastname: Hellmann
authors.forename: Matthias
authors.initials: M
authors.lastname: Maass
authors.forename: Evangelos
authors.initials: E
authors.lastname: Giannitsis
authors.forename: Klaus
authors.initials: K
authors.lastname: Dalhoff
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Katus
mesh_terms: D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000097:blood* / Q000175:diagnosis; D001145:Arrhythmias, Cardiac; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D013223:Statistics as Topic; D013577:Syndrome; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein