Title: Prognostic Role of High Sensitivity C- Reactive Protein in Acute Myocardial Infarction
Authors: Praveen P, Sunil Prasobh P
DOI: https://dx.doi.org/10.18535/jmscr/v6i3.13
Abstract
Background: C reactive protein (CRP) is an acute phase protein, whose concentrations increase during inflammatory states.CRP, a marker of inflammation has been shown to predict incident MI, stroke, peripheral arterial disease and sudden cardiac death. It has also been shown to predict risk of both recurrent ischemia and death among those with acute coronary syndromes. It has been found that hsCRP consistently predicts new coronary events in patients with MI and unstable angina. In acute Myocardial infarction, hsCRP consistently predicts recurrent MI independent of Troponins.
The aim of the study was to examine the baseline hsCRP values in acute myocardial infarction and to compare it with normal population, so as to study the prognostic value of hsCRP in predicting acute myocardial infarction. Also to find out the correlation between CRP levels and in hospital complications and ST segment resolution after thrombolysis with streptokinase.
Materials and methods: This was a case control study conducted in 50 patients admitted with acute ST elevation myocardial infarction within three hours of onset of index chest pain in the intensive coronary care unit under the department of medicine in a tertiary care centre in South kerala. Samples were sent for hs CRP at admission. All patients underwent thorough clinical examination and investigations. They were closely followed up for in hospital complications .ST segment resolution after thrombolysis were also assessed. 50 normal healthy age and sex matched individuals were also selected and studied.
Results: The study was conducted among 50 cases and 50 control groups. The mean hs CRP of cases were 4.35mg/L while that of control were 1.61mg/L. About 54% of the cases had hs CRP above 3 mg/L while only 32% of the control had above 3mg/L. Of the 50 cases who developed myocardial infarction 38% had anterior wall and 16% inferior wall myocadial infarction. Both inferior wall and right ventricular wall myocardial infarction was seen in 18%, while inferior wall and posterior wall myocardial infarction was seen in 18%.Rest 10% of the cases developed a combination of inferior, posterior and lateral wall myocardial infarction. Reperfusion was absent in 42% of cases who had mean hs CRP value of 4.51mg/L. Eight percent of cases who had mean hs CRP 7.8 mg/L died..The percentage of cases who developed in hospital complications of myocardial infarction like post infarction angina, cardiac failure, arrhythmias, and death were 28%,26%,34%,and 8% respectively.
Conclusions: The hsCRP an inflammatory marker was significantly higher in cases with acute myocardial infarction. Higher levels of admission hsCRP levels were associated with increased in hospital complications including death, cardiac failure, arrhythmias and post infarction angina. Among the complications correlation of higher hsCRP levels with cardiac failure was statistically significant. Mortality after myocardial infarction was correlated with higher hs CRP levels. Higher hs CRP levels were significantly associated with lower rates of reperfusion after thrombolysis with streptokinase.
Keywords: hsCRP, myocardial infarction, streptokinase, thrombolysis, acute phase protein.
References
- Reddy KS,Yusuf S.Emerging epidemic of cardiovascular disease in developing Circulation 1998,97;596-601
- Ridker PM. elal Clinical application of CRP for cardiovascular disease detection and prevention. Circulation. 2003; 107:363-369
- Blake GJ et al Inflammatory biomarkers and cardiovascular risk prediction. J Intern Med 2002;252;283-94
- Pasceri V et al .Direct proinflammatory effect of C-reactive protein on human endothelial cells. Circulation, 2000;102(18);2165-8
- Ginnetti F,Angiolillo DJ,Grieco G, Liuzzo G,Maseri A.Predictive role ofC-reactive protein.Am Heart J2002;105;800-3.
- Tomoda H et al .Prognostic value of C-reactive proteinlevels witin six hours after te onset of acute myocardialin farction. Am eartJ.200;140(2);324-8
- Sund M, Frohlich M, Koening W, C reactive protein, a sensitive marker of inflammation predicts future risk of coronary heart disease in initially healthy middle aged men, results from the Monica Cohort study. Circulation. 1999; 99: 237-242
- Berk BC et al Elevation of C-reactive protein in “active” coronary artery disease. Am J Cardiol 1990;65;168-72
- Tomassi S, Carluccio E, Bentivoglio M. C reactive protein as a marker for cardiac ischemic events in a first uncomplicated Myocardial infarction. Am J Cardiol 1999; 83; 1595-1599.,
- JS, Anderson JL, Benjamin. D, Usefulness of high sensitivity C reactive protein in predicting long term risk of death or acute Myocardial infarction in patients with unstable angina or Myocardial infarction. Am J, Cardiol 2002; 89: 145-149.
- Deepak Y Kamath et al, “High sensitivity C reactive protein (hs CRP) & cardiovascular disease; An Indian perspective: Indian JMed Res.2015 Sep;142(3);261 -268
- Badiger RH et a l” hs C-reactive protein as an indicator for prognosis in acute myocardial infarction”. J SciSoc 2014;41;118-2.
- Morrow DA, Rifai N, Antman EM. C-reactive protein is apotent predictor of mortality independently and incombination with troponin T in acute coronary syndromes. J Am Coll Cardiol1981 ;31: 146—1465.
- Rajeev Gupta. Epidemiological evolution and rise of coronary eart disease in India. South Asian J Preventive Cardiology 1997;1; 14-20
- T'oshihisa A. etal. C reactive protein as a predictor of infarct expansion and Cardiac rupture after a first q wave acute myocardial infarction. Circulation 1997 ; 96: 778-784.
- Gupta OP, C reactive Protein and cardiovascular disease - an update. Medicine update APICON 2004; 14: 40-42.