Relationship between C-reactive protein and the electrocardiographic pattern on admission in patients with acute
Pedro L Sánchez1, Igor F Palacios, Pedro Pabón
1Cardiology Department, University Hospital, Salamanca, Spain. pedrolsanchez@secardiologia.es
Insights
Inflammation, indicated by C-reactive protein (CRP), is more prevalent in acute coronary syndrome (ACS) patients with ST depression or T-wave inversion on ECG. This suggests varied inflammatory roles in coronary instability.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Acute coronary syndrome (ACS) involves inflammation, with C-reactive protein (CRP) as a key marker.
- The prevalence of elevated CRP in ACS patients varies significantly.
- Understanding inflammation's role across different electrocardiographic (ECG) patterns is crucial.
Purpose of the Study:
- To determine the prevalence of inflammation (elevated CRP) in ACS patients.
- To analyze CRP levels based on admission ECG patterns (ST elevation, ST depression/T-wave inversion, no changes).
Main Methods:
- 136 acute myocardial infarction patients were categorized into three ECG groups.
- CRP levels were measured on admission using a 3 mg/l cutoff for inflammation.
- One-year follow-up assessed outcomes: coronary death, myocardial infarction, and instability recurrence.
Main Results:
- Elevated CRP was significantly more common in patients with ST depression/T-wave inversion (70%) compared to ST elevation (44.1%) or no ECG changes (40.7%).
- Patients with elevated CRP and ST depression/T-wave inversion showed poorer one-year outcomes (74% vs. 27%).
- Higher CRP levels correlated with worse outcomes across all ECG groups.
Conclusions:
- ST depression or T-wave inversion on admission in ACS patients is associated with a higher prevalence of elevated CRP.
- This indicates significant heterogeneity in the inflammatory contribution to coronary instability syndromes.
- CRP levels and ECG patterns offer prognostic information in ACS.
Background:
In patients with acute coronary syndrome (ACS), the prevalence of a primary inflammatory pathogenic component of coronary instability, as detectable by elevated C-reactive protein (CRP), varies considerably. The aim of the present study was to assess the prevalence of inflammation in patients with ACS according to the different electrocardiographic (ECG) patterns on admission.
Methods:
Hundred and thirty-six consecutive patients with the diagnosis of acute myocardial infarction were divided in three groups according to the ECG pattern on admission. Group 1 included 59 patients with ST segment elevation, group 2 included 50 patients with ST depression and/or T wave inversion and group 3 included 27 patients with no ECG changes. CRP was measured on admission in all patients. For the prevalence of inflammation analysis, we used a cutoff value of 3 mg/l.
Results:
CRP was above cutpoint significantly more often in patients with ST depression and/or T wave inversion (44.1% in group 1, 70% in group 2 and 40.7% in group 3; p=0.009). Patients with similar ECG pattern and CRP levels above the cutpoint presented a poorer outcome (coronary death, myocardial infarction and recurrence of instability) at one-year follow-up: 54 versus 27% for group 1, 74 versus 27% for group 2 and 45 versus 31% for group 3.
Conclusions:
Patients with ST depression and/or T wave inversion on admission exhibit a higher prevalence of elevated CRP than those with ST elevation or no ECG changes, suggesting an important heterogeneity of the role of inflammatory triggers of the clinical syndromes of coronary instability.
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