title: High-sensitivity C-reactive protein is within normal levels at the very onset of first ST-segment elevation acute myocardial infarction in 41% of cases: a multiethnic case-control study.
abstract: OBJECTIVE
  This study sought to assess the prevalence of normal levels of high sensitivity C-reactive protein (hsCRP) at the very onset of ST-segment elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Levels of hsCRP ≥2 mg/l identify individuals who benefit from lipid lowering and possibly anti-inflammatory agents, but how many patients develop infarction in spite of hsCRP levels <2 mg/l and thus would be ineligible for these treatments?
  
  
  METHODS
  We studied 887 patients with unequivocally documented STEMI as the first manifestation of coronary disease and 887 matched control subjects from urban areas of Italy, Scotland, and China. Blood samples were obtained before reperfusion strategies <6 h from symptoms onset in order to limit acute event-related increases.
  
  
  RESULTS
  hsCRP values were similar in samples obtained <2 h, 2 to 4 h, and 4 to 6 h from symptoms onset in all ethnic groups, consistent with the delayed hsCRP elevation after myocardial necrosis and thus indicative of pre-infarction levels. Median hsCRP values were significantly higher in patients than in control subjects: 2.49 (interquartile range [IQR]: 1.18 to 5.55) mg/l versus 1.32 (IQR: 0.58 to 3.10) mg/l (p < 0.0001), which is consistent with previous findings. However, 41% of patients had hsCRP levels <2 mg/l and conversely, 37% of control subjects had values ≥2 mg/l.
  
  
  CONCLUSIONS
  The measurement of hsCRP, with a 2 mg/l cutoff, would not have predicted 41% of unequivocally documented STEMIs in 3 ethnic groups without evidence of previous coronary disease, thus indicating both its limitations as an individual prognostic marker and as an indicator of a generalized inflammatory pathogenetic component of STEMI. New specific prognostic and therapeutic approaches should be found for such a large fraction of patients at risk.
authors.affiliation: Università Vita-Salute San Raffaele, Istituto Scientifico San Raffaele, Milan, Italy.
authors.forename: Nicole
authors.initials: N
authors.lastname: Cristell
authors.forename: Domenico
authors.initials: D
authors.lastname: Cianflone
authors.forename: Alessandro
authors.initials: A
authors.lastname: Durante
authors.forename: Enrico
authors.initials: E
authors.lastname: Ammirati
authors.forename: Diego
authors.initials: D
authors.lastname: Vanuzzo
authors.forename: Michela
authors.initials: M
authors.lastname: Banfi
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Marenzi
authors.forename: Monica
authors.initials: M
authors.lastname: De Metrio
authors.forename: Luciano
authors.initials: L
authors.lastname: Moretti
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Neal G
authors.initials: NG
authors.lastname: Uren
authors.forename: Dayi
authors.initials: D
authors.lastname: Hu
authors.forename: Attilio
authors.initials: A
authors.lastname: Maseri
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D016022:Case-Control Studies; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000175:diagnosis / Q000208:ethnology*; D011237:Predictive Value of Tests; D015995:Prevalence
chemical_list: D002097:C-Reactive Protein