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Category: Volume 06 Issue 11 November 2018
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Title: Level of C-Reactive Protein in Prognosis of Unstable Angina and Non St Elevation Myocardial Infarction

Authors: Dr P.K. Agrawal, Dr Atul Kumar, Dr Md Tabrez Alam, Dr Usman Rasool, Dr Raghib Hasan, Dr Farogh  Haidry, Dr Rakesh Raushan

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i11.44

Abstract

Introduction: Acute coronary syndrome (ACS) is defined as a sudden and rapid compromise of coronary blood flow usually because of rupture of an atherosclerotic lesion and subsequent thrombus formation in the coronary artery. It includes ST Elevated MI, UNSTABLE ANGINE and NON-ST Elevation MI.

C Reactive Protin is an acute phase protein produced mainly by the liver in response to intereukin 6, is a marker of inflammatory processes that contribute importantly to atherogenesis, plaque disruption and thrombosis.

Aims And Objectives

  • To find out the number of the patients with acute coronary syndrome (unstable angina and non ST elevation MI) that have raised C-reactive protein.
  • Whether there is any correlation between the severity of acute coronary syndrome and the quantitative and qualitative estimation of C-reactive protein.
  • To assess whether level of C-reactive protein bears a positive correlation with the level of cardiac enzymes.
  • To assess whether the C-reactive protein could be considered as one of the factors for risk stratification of acute coronary syndrome

Materials and Method: 60 patients of acute coronary syndrome (unstable angina and non-ST elevation MI) admitted in Intensive Coronary Care Unit (ICCU) of Katihar Medical College & Hospital  along with 30 age and sex matched healthy person as control were formed the material of the study.

Type of Study: Descriptive Study

Inclusion Criteria

  • Adult patients of both sexes
  • Informed and a written consent
  • The patient may be either a known case of ischaemic heart disease or the present attack of unstable angina may be the first manifestation of the disease.

Exclusion Criteria

  • ST –Elevated Myocardial infarction
  • Any infective or inflammatory and neoplastic condition that is known to be associated with an acute phase response thereby causing a rise in (CRP) C-reactive protein.
  • post-infarct angina patients.

Duration of Study: December 2016 to May 2018

Results: At 0hr., 20% of patients had negative C-reactive protein (CRP) levels while 80% of the population had positive C-reactive protein (CRP) levels. This was equally distributed over the 3 frequency distribution ((viz. 6<12, 12 -<24 and 24 – 48). Those who had initial negative C-reactive protein (CRP) values remained so throughout 24 hrs following admission. At 6hrs, 23.33% had CRP values between 6 - <12, 30% had C-reactive protein (CRP) 12 -<24 while, 26.67% had values > 24 gm/L. At 24 hr, 36.67% had values between 6 -<12, while 16.66% of population still had very high(>24gm/L) C-reactive protein (CRP) levels.

The incidence of risk factors in the study group shows diabetes mellitus was present in 26 patients (43.33%). Thirty-two patients (53.33%) gave history of smoking. Forty patients (66.67%) were hypertensive and 24 patients (40%) were dyslipidaemics. Past history of IHD was present in 26 patients (43.33%). Hypertension was detected to be present in majority of the patients (Table-2).

Conclusion: The present study has  shown a positive correlationship between raised C-reactive protein (CRP),  high incidence of MACE and poor outcome both immediate and 1 year and 6 months follow up. There is high incidence in diabetcis and smokers and hypertensives.

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Corresponding Author

Dr Md Tabrez Alam

Post Graduate Trainee, Department of General Medicine, KMCH Katihar, India