Early inflammation and risk of long-term development of heart failure and mortality in survivors of acute myocardial infarction predictive role of C-reactive protein.
OBJECTIVE
We aimed to study the relationship between C-reactive-protein (CRP), obtained within 12 to 24 h of symptoms onset, and long-term risk of death and heart failure (HF) in survivors of acute myocardial infarction (MI).


BACKGROUND
A robust inflammatory response is an integral component of the response to tissue injury during MI. The magnitude of the early inflammatory response to ischemic injury might be an important determinant of long-term outcome.


METHODS
We prospectively studied 1,044 patients admitted with acute MI and discharged from hospital in stable condition.


RESULTS
During a median follow-up of 23 months (range, 6 to 42 months), 113 patients died and 112 developed HF. In a multivariable Cox regression model adjusting for clinical variables and predischarge ejection fraction, compared with patients in the first CRP quartile, the adjusted hazard ratios (HRs) for death progressively increased with higher quartiles of CRP (second quartile 1.4 [95% confidence interval (CI) 0.6 to 2.9]; third quartile 2.3 [95% CI 1.2 to 4.6]; fourth quartile 3.0 [95% CI 1.5 to 5.7]; for trend, p = 0.0002). Compared with patients in the first CRP quartile, the adjusted HRs for HF were: second quartile, 1.1 (95% CI 0.5 to 2.3); third quartile, 1.9 (95% CI 1.0 to 3.6); and fourth quartile, 2.1 (95% CI 1.2 to 3.9) (for trend, p = 0.005).


CONCLUSIONS
C-reactive-protein is a marker of long-term development of HF and mortality in patients with acute MI and provides prognostic information beyond that provided by conventional risk factors and the degree of left ventricular systolic dysfunction.
Suleiman
Mahmoud
M
Department of Cardiology, Rambam Medical Center and the Bruce Rappaport faculty of medicine, Haifa, Israel.
Khatib
Rania
R
Agmon
Yoram
Y
Mahamid
Riad
R
Boulos
Monther
M
Kapeliovich
Michael
M
Levy
Yishai
Y
Beyar
Rafael
R
Markiewicz
Walter
W
Hammerman
Haim
H
Aronson
Doron
D
D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D007249:Inflammation / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications / Q000401:mortality*; D011446:Prospective Studies; D012307:Risk Factors; D017741:Survivors; D013997:Time Factors
D002097:C-Reactive Protein