C-reactive protein, infarct size, microvascular obstruction, and left-ventricular remodelling following acute myocardial infarction.
OBJECTIVE
This study assessed the relationship between inflammatory mediators and indices of infarct size and left-ventricular (LV) remodelling following successful primary percutaneous coronary intervention (PCI) in patients with first time ST elevation myocardial infarction (MI).


RESULTS
Forty-two patients admitted with an occluded single vessel were recruited consecutively. Cardiac magnetic resonance was used for serial assessment (2 days, 1 week, 2 months) of infarct size, microvascular obstruction (MO), and LV remodelling. Inflammatory mediators were analysed before and after PCI. Our major findings were: (1) Following PCI, there was a marked increase in plasma levels of C-reactive protein, closely correlated with an increase in interleukin-6 and terminal complement complex, reaching maximum 2 days after PCI; (2) C-reactive protein 2 days after PCI was significantly correlated with infarct size and parameters of LV remodelling 2 months after PCI; (3) Patients with persistent MO had significantly higher C-reactive protein levels 2 days following PCI.


CONCLUSIONS
We suggest that the rapid increase in C-reactive protein levels in this model of successful revascularization of a single, totally occluded vessel reflects the degree of inflammation within the infarcted area. Our findings support a role for C-reactive protein-mediated complement activation as both a marker and mediator of myocardial damage following MI. Clinical study no.: NCT 00465868.
Ørn
Stein
S
Division of Cardiology, Stavanger University Hospital, PO 8400, 4068 Stavanger, Norway. drsteinorn@hotmail.com
Manhenke
Cord
C
Ueland
Thor
T
Damås
Jan K
JK
Mollnes
Tom Eirik
TE
Edvardsen
Thor
T
Aukrust
Pål
P
Dickstein
Kenneth
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002097:C-Reactive Protein / Q000378:metabolism*; D015938:Complement Membrane Attack Complex / Q000378:metabolism; D003326:Coronary Circulation; D004562:Electrocardiography; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009203:Myocardial Infarction / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D011446:Prospective Studies; D018401:Sample Size; D018709:Statistics, Nonparametric; D015607:Stents; D013997:Time Factors; D020107:Troponin T / Q000097:blood / Q000378:metabolism; D020257:Ventricular Remodeling
D015938:Complement Membrane Attack Complex; D018836:Inflammation Mediators; D015850:Interleukin-6; D020107:Troponin T; D002097:C-Reactive Protein