Impact of baseline and serial C-reactive protein on the future cardiovascular death in patients with acute myocardial infarction after percutaneous coronary intervention

C-reactive protein (CRP) is an established inflammatory biomarker and associated with short-term adverse outcomes after acute myocardial infarction (AMI). It remains unclear whether baseline and serial CRP levels were associated with long term clinical outcomes in patients with AMI.

The aim of the present study was to evaluate the impact of baseline and serial CRP levels on long-term cardiovascular death in patients with AMI.

We retrospectively investigated 2006 consecutive patients with AMI who underwent percutaneous coronary intervention (PCI) in our institution from January 2004 to December 2017. The primary outcome was cardiovascular (CV) death and 30-day landmark analysis was performed.

The 1603 eligible AMI patients were divided into following three groups according to baseline CRP levels: Low CRP <0.3 mg/dL, n=288; Intermediate CRP 0.3-0.4 mg/dL, n=784; High CRP >0.4mg/dL, n=531. The mean age was 69 years, 76% of patients were male, STEMI was seen in 88%. Landmark Kaplan-Meier analysis showed that the rate of CV death after 30 days was significantly and dose-dependently increased with baseline CRP levels (Log rank P = 0.0107, P for trend P = 0.0013) but not with CRP levels at discharge (P = 0.77). Multivariate Cox regression analysis showed a higher baseline CRP levels was significantly associated with greater risk of CV death (adjusted HR 1.33, 95%CI 1.08-1.65, P = 0.0072).

Inflammation in the early phase after AMI was associated with future cardiovascular death beyond 30 days and up to 3 years.Figure 1

(Study Flow Chart)