CLINICAL RESEARCH: ACUTE MYOCARDIAL INFARCTION
Early Inflammation and Risk of Long-Term Development of Heart Failure and Mortality in Survivors of Acute Myocardial Infarction
Predictive Role of C-Reactive Protein
Mahmoud Suleiman, MD*,
Rania Khatib*,
Yoram Agmon, MD*,
Riad Mahamid, MD*,
Monther Boulos, MD ,
Michael Kapeliovich, MD, PhD*,
Yishai Levy, MD,
Rafael Beyar, MD, DSc*,
Walter Markiewicz, MD*,
Haim Hammerman, MD* and
Doron Aronson, MD*,*
* Department of Cardiology, Rambam Medical Center and the Bruce Rappaport faculty of medicine, Haifa, Israel
Department of Internal Medicine D, Rambam Medical Center and the Bruce Rappaport faculty of medicine, Haifa, Israel
Manuscript received July 25, 2005;
revised manuscript received October 6, 2005,
accepted October 17, 2005.
* Reprint requests and correspondence: Dr. Doron Aronson, Department of Cardiology, Rambam Medical Center, PO Box 9602, Haifa 31096, Israel (Email: d_aronson{at}rambam.health.gov.il).
OBJECTIVES: We aimed to study the relationship between C-reactive-protein (CRP), obtained within 12 to 24 h of symptoms onset, and long-term risk of death and heart failure (HF) in survivors of acute myocardial infarction (MI).
BACKGROUND: A robust inflammatory response is an integral component of the response to tissue injury during MI. The magnitude of the early inflammatory response to ischemic injury might be an important determinant of long-term outcome.
METHODS: We prospectively studied 1,044 patients admitted with acute MI and discharged from hospital in stable condition.
RESULTS: During a median follow-up of 23 months (range, 6 to 42 months), 113 patients died and 112 developed HF. In a multivariable Cox regression model adjusting for clinical variables and predischarge ejection fraction, compared with patients in the first CRP quartile, the adjusted hazard ratios (HRs) for death progressively increased with higher quartiles of CRP (second quartile 1.4 [95% confidence interval (CI) 0.6 to 2.9]; third quartile 2.3 [95% CI 1.2 to 4.6]; fourth quartile 3.0 [95% CI 1.5 to 5.7]; for trend, p = 0.0002). Compared with patients in the first CRP quartile, the adjusted HRs for HF were: second quartile, 1.1 (95% CI 0.5 to 2.3); third quartile, 1.9 (95% CI 1.0 to 3.6); and fourth quartile, 2.1 (95% CI 1.2 to 3.9) (for trend, p = 0.005).
CONCLUSIONS: C-reactive-protein is a marker of long-term development of HF and mortality in patients with acute MI and provides prognostic information beyond that provided by conventional risk factors and the degree of left ventricular systolic dysfunction.
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Abbreviations and Acronyms
| | BNP = B-type natriuretic peptide | | CI = confidence interval | | CK = creatine kinase | | CRP = C-reactive protein | | EF = ejection fraction | | HF = heart failure | | HR = hazard ratio | | LV = left ventricle/ventricular | | MI = myocardial infarction |
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