Impact of C-reactive protein on long-term mortality in acute myocardial infarction patients with diabetes and those without

et al. 2020

Preprint

Background: High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM.Methods: We prospectively included 2,064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint.Results: Twenty-six percent (n=548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P<0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend <0.0001), in DM (14%, 9%, 21%, 27%; P=0.0001), and non-DM (5%, 8%, 10%, 19%; P<0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value >2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value >2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients.Conclusions: This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

et al. 2020

Preprint

“…However, these studies were retrospective analyses of registries including old study populations (enrolled between 1998 and 2004), they considered patients with an outdated DM de nition [26,27], and, in one study [27], traditional CRP was assessed. More recently, Xia et al [28] found that CRP predicts three-year mortality in both DM and non-DM patients with AMI. Yet, in this study, the prognostic relevance of CRP was analyzed according to the CRP median value (8.9 mg/L), a cutoff that may encompass patients with the highest degree of in ammation [28].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, Xia et al [28] found that CRP predicts three-year mortality in both DM and non-DM patients with AMI. Yet, in this study, the prognostic relevance of CRP was analyzed according to the CRP median value (8.9 mg/L), a cutoff that may encompass patients with the highest degree of in ammation [28]. Thus, the possible different prognostic impact of hs-CRP in AMI patients with and without DM remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Prognostic Impact of Admission High-Sensitivity C-Reactive Protein in Acute Myocardial Infarction Patients With and Without Diabetes Mellitus

et al. 2020

Preprint

Background: High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM. Methods: We prospectively included 2,064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint. Results: Twenty-six percent (n=548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P<0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend <0.0001), in DM (14%, 9%, 21%, 27%; P=0.0001), and non-DM (5%, 8%, 10%, 19%; P<0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value >2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value >2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients. Conclusions: This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.

“…However, these studies were retrospective analyses of registries including old study populations (enrolled between 1998 and 2004), they considered patients with an outdated DM definition [28,29], and, in one study [29], traditional CRP was assessed. More recently, Xia et al [30] found that CRP predicts threeyear mortality in both DM and non-DM patients with AMI. Yet, in this study, the prognostic relevance of CRP was analyzed according to the CRP median value (8.9 mg/L), a cutoff that may encompass patients with the highest degree of inflammation [30].…”

Section: Inflammation and Dm In Amimentioning

confidence: 99%

Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus

et al. 2020

Cardiovasc Diabetol

Background High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM. Methods We prospectively included 2064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint. Results Twenty-six percent (n = 548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P < 0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend < 0.0001), in DM (14%, 9%, 21%, 27%; P = 0.0001), and non-DM (5%, 8%, 10%, 19%; P < 0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value ≥ 2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value ≥ 2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients. Conclusions This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.