Prognostic value of C-reactive protein and cardiac troponin I in primary percutaneous interventions for ST-elevation myocardial infarction.
BACKGROUND
The rise in cardiac troponin I after ST-elevation myocardial infarction treated by primary percutaneous coronary interventions (PCIs) is predictive of infarct size and left ventricular ejection fraction (LVEF). However, the comparative value of C-reactive protein (CRP) and troponin I for infarct size evaluation and the respective relationships between these biomarkers and mortality have not been investigated.


METHODS
We studied 87 patients who underwent primary PCI for ST-elevation myocardial infarction. Concentrations of troponin I and CRP were measured before and for 72 hours after PCI. Infarct size was measured by the cumulative release of alpha-hydroxybutyrate deshydrogenase during the 72 hours after PCI (QHBDH72) and by delayed radionuclide LVEF (at 4.6 +/- 1.7 weeks).


RESULTS
Concentrations of CRP at peak and at 24, 48 and 72 hours, and of troponin I at 6 and 72 hours, correlated with QHBDH72 and LVEF. In single variable analysis, at a mean follow-up of 42 +/- 8 months, Killip score of 3 to 4, CRP at baseline and at 48 hours, and troponin I at 6 and 72 hours were related to mortality. By multiple variable analysis, Killip score (OR 9.9, CI 1.6-58.8) and troponin I at 72 hours (OR 9.43, CI 2.1-43.5) were the only independent predictors of mortality.


CONCLUSIONS
Plasma concentrations of CRP and troponin I after PCI were related to infarct size and mortality. However, Killip class and troponin I at 72 hours were the only independent predictors of mortality at long-term follow-up.
Ohlmann
Patrick
P
Department of Cardiology, Hospital of Mulhouse, 68070 Mulhouse Cedex, France. patrick.ohlmann@chru-strasbourg.fr
Jaquemin
Laurent
L
Morel
Olivier
O
El Behlgiti
Rachid
R
Faure
Antoine
A
Michotey
Marie-Odile
MO
Beranger
Nathalie
N
Roul
Gerald
G
Schneider
Francis
F
Bareiss
Pierce
P
Monassier
Jean-Pierre
JP
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D002097:C-Reactive Protein / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000401:mortality; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006884:Hydroxybutyrate Dehydrogenase / Q000097:blood; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000378:metabolism*; D009994:Osmolar Concentration; D011237:Predictive Value of Tests; D011379:Prognosis; D015635:Radionuclide Ventriculography; D015607:Stents / Q000009:adverse effects; D013318:Stroke Volume; D013997:Time Factors; D019210:Troponin I / Q000097:blood*
D019210:Troponin I; D002097:C-Reactive Protein; D006884:Hydroxybutyrate Dehydrogenase