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

Abstract

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.

Prognostic value of subclinical myocardial necrosis using high-sensitivity cardiac troponin T in patients with prediabetes

“…We also observed higher levels of hsCRP with increasing hs-cTnT levels. In a recent study, Lucci et al prospectively followed 2064 patients with acute myocardial infarction and found that hsCRP levels predicted mortality and were correlated with hs-cTnI both in patients with and without diabetes [ 42 ]. Although the link between CRP and SMN in stable patients warrants further investigation adjusting for hsCRP did not change the association of hs-cTnT in our prediabetic cohort (Additional file 1 : Tables S1–S3).…”

Low-grade inflammation as a risk factor for cardiovascular events and all-cause mortality in patients with type 2 diabetes

“…In various populations low-grade inflammation has indeed been related to a higher risk of cardiovascular events and cardiovascular mortality [ 15 – 17 ]. In acute myocardial infarction patients with and without DM, hs-CRP predicts in-hospital outcome and two-year mortality [ 18 ]. It has also been shown that lowering low-grade inflammation in patients with coronary artery disease with or without type 2 diabetes reduces the residual risk for cardiovascular events [ 19 ].…”

Cardiogenic Shock Does Not Portend Poor Long-Term Survival in Patients Undergoing Primary Percutaneous Coronary Intervention

“…In addition, significantly elevated initial C-reactive protein (CRP) values in the CS cohort indicate a marked systemic inflammatory response in these patients. Elevated CRP levels represent a prognostically unfavourable situation, as it has been proven to be predictable for increased rates of adverse cardiac events, poor in-hospital outcomes, acute kidney injury, and mortality [ 23 , 24 , 25 , 26 ].…”