The Impact of Ischemic Time on the Predictive Value of High-Sensitivity C-Reactive Protein in ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Coronary Intervention

Abstract

Background and ObjectivesThe high-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, has been known to be elevated in patients with coronary artery disease. However, there is controversy about the predictive value of hs-CRP after acute myocardial infarction (MI). Therefore, we evaluated the impact of ischemic time on the predictive value of hs-CRP in ST-segment elevation myocardial infarction (STEMI) patients who were treated by primary percutaneous coronary intervention (PCI).Subjects and MethodsWe enrolled 5123 STEMI patients treated by primary PCI from the Korean Working Group in Myocardial Infarction and divided enrolled patients into four groups by symptom-to-balloon time (SBT) and level of hs-CRP (Group I: SBT <6 hours and hs-CRP <3 mg/L, Group II: SBT <6 hours and hs-CRP ≥3 mg/L, Group III: SBT ≥6 hours and hs-CRP <3 mg/L, and Group IV: SBT ≥6 hours and hs-CRP ≥3 mg/L). To evaluate the impact of ischemic time on the predictive value of hs-CRP in STEMI patients, we compared the cumulative cardiac event-free survival rate between these four groups.ResultsThe sum of the cumulative incidence of all-cause mortality and recurrence of MI was higher in Group IV than in the other groups. However, there was no significant difference among Group I, Group II, and Group III. The Cox-regression analyses showed that an elevated level of hs-CRP (≥3 mg/L) was an independent predictor of long-term cardiovascular outcomes only among late-presenting STEMI patients (p=0.017, hazard ratio=2.462).ConclusionFor STEMI patients with a long ischemic time (≥6 hours), an elevated level of hs-CRP is a poor prognostic factor of long-term cardiovascular outcomes.

Thrombomodulin can predict the incidence of second events in patients with acute coronary syndrome: Single-center, retrospective cohort study

“…However, there were no significant correlations between MACEs and elevated CRP after PCI in our study. Other studies [32][33][34] also reported that elevated CRP levels reflect MACE in patients with ACS. Some reports [35,36] defined MACEs as pure coronary events such as target vessel revascularization, MI, and in-stent restenosis.…”

Prognostic significance of inflammatory biomarkers in diabetic and non-diabetic patients with STEMI, treated with primary percutaneous coronary intervention

“…The influence of other risk factors on CRP values such as smoking cigarettes, presence of arterial hypertension, or even female gender are reported in some papers [18][19][20] . Prolonged ischemic time has also influence on the increased CRP levels 21 . However, in the multivariate survival analyses, when putting all these risk factors into one model using the Cox regression, CRP still emerges as the best independent predictor of early mortality in the patients without diabetes.…”

“…One of the possible answers might be that the acute glucose fluctuation in the nondiabetic STEMI patients triggers more oxidative stress compared with sustained chronic hyperglycemia in the patients with diabetes type 2 22 . It is also known that acute hyperglycemia in STEMI is an independent risk factor for adverse events and that can even potentiate stress-induced apoptosis [19][20][21] .…”

High-sensitivity C-reactive protein and long term reperfusion success of primary percutaneous intervention in ST-elevation myocardial infarction

“…The ischemic time might, in part, also explain the higher hs-CRP levels in these patients at baseline. We also measured hs-CRP at 2 weeks, 7 weeks and 4 months after admission, and in addition to Patti et al we report on the temporal course of hs-CRP in STEMI patients [8,9,18,19]. In addition, we used more sensitive assay to determine the hs-CRP levels, allowing detection of CRP below 5 mg/l and facilitating the detection of subtle differences between patients with normal and impaired reperfusion.…”

“…Previous data suggested that a higher level of hs-CRP (≥3 mg/l) is an independent predictor of long-term clinical outcomes in late-presenting STEMI patients (i.e. ischemia time ≥ 6 h) [18]. We investigated whether ischemia time, hsCRP and reperfusion were associated.…”