title: Admission C-reactive protein serum levels and survival in patients with acute myocardial infarction with persistent ST elevation.
abstract: OBJECTIVE
  To evaluate the prognostic value of a single and early determination of high sensitivity C-reactive protein levels at admittance in patients with acute myocardial infarction with persistent ST elevation.
  
  
  METHODS
  We evaluated high-sensitivity C-reactive protein levels in 247 consecutive acute myocardial infarction with persistent ST elevation patients at admittance. Patients were monitored for the occurrence of major adverse cardiovascular events.
  
  
  RESULTS
  Mean follow-up was 26 months. High C-reactive protein levels were principally associated with age > or = 65 years (P=0.01), diabetes (P=0.03) and reduced left ventricle ejection fraction (P=0.048). We observed a significant C-reactive protein level difference between the major adverse cardiovascular event-free group and the major adverse cardiovascular event group (28.2+/-21.9 vs. 47.7+/-31.9 mg/l, P=0.03), between deceased patients group (vs. 81.5+/-51.8 mg/l, P<0.001) and early deaths (vs. 129.5+/-71.9 mg/l, P<0.001). Kaplan-Meier plots for survival and major adverse cardiovascular event occurrence showed a significant separation (P=0.01 and 0.002 by log-rank test, respectively) between high and low C-reactive protein level groups. C-reactive protein levels were independent risk predictors of major adverse cardiovascular events (odds ratio 2.931, 95% confidence interval 1.512-5.893; P=0.046) and death (odds ratio 5.068, 95% confidence interval 2.056-20.195; P=0.04). Patients with high C-reactive protein levels and age > or = 65 years were at highest risk for major adverse cardiovascular event occurrence (odds ratio 5.658, 95% confidence interval 2.898-6.249; P=0.022) and death (odds ratio 8.120, 95% confidence interval 5.656-22.729; P=0.03).
  
  
  CONCLUSIONS
  High C-reactive protein levels identify patients with a worse prognosis after acute myocardial infarction with persistent ST elevation. The evaluation of C-reactive protein and age may provide a tool to select high-risk patients.
authors.affiliation: Division of Cardiology, Cardio-Thoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy. marialauracanale@katamail.com
authors.forename: Maria L
authors.initials: ML
authors.lastname: Canale
authors.forename: Stefano
authors.initials: S
authors.lastname: Stroppa
authors.forename: Paolo
authors.initials: P
authors.lastname: Caravelli
authors.forename: Anna S
authors.initials: AS
authors.lastname: Petronio
authors.forename: Rita
authors.initials: R
authors.lastname: Mariotti
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
authors.forename: Alberto
authors.initials: A
authors.lastname: Balbarini
authors.forename: Antonio
authors.initials: A
authors.lastname: Barsotti
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000401:mortality / Q000503:physiopathology; D009391:Nephelometry and Turbidimetry; D010343:Patient Admission; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein