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Acute Myocardial Infarction in Rats
Published on: February 16, 2011
Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial
Dong Oh Kang1, Yoonjee Park1, Ji Hoon Seo2
1Cardiovascular Center, Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
Insights
Elevated high-sensitivity C-reactive protein (hs-CRP) levels predict cardiovascular events in acute myocardial infarction (AMI) patients within 6 months post-procedure. High-intensity statin therapy consistently improves outcomes regardless of initial hs-CRP levels.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Outcomes
Background:
- Elevated high-sensitivity C-reactive protein (hs-CRP) is a prognostic indicator for cardiovascular events in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).
- The prognostic value of baseline hs-CRP and its temporal relationship with outcomes in AMI patients on statin therapy require further clarification.
Purpose of the Study:
- To determine the optimal time-period for assessing the prognostic value of baseline hs-CRP in predicting cardiovascular outcomes.
- To evaluate the impact of statin therapy intensity on the prognostic significance of hs-CRP in AMI patients.
Main Methods:
- Analysis of 4410 AMI patients from the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry.
- Patients were stratified by baseline hs-CRP levels (1.0, 3.0, 10.0 mg/L) and statin therapy intensity.
- Primary outcome: 36-month major adverse cardiovascular events (MACE); Secondary outcomes: MACE at 0-6, 6-12, and 12-36 months.
Main Results:
- Higher baseline hs-CRP levels correlated with increased 36-month MACE incidence.
- The prognostic effect of hs-CRP was most pronounced within the first 6 months post-AMI.
- This prognostic effect diminished after 6 months, with high-intensity statin use showing consistent outcome improvement.
Conclusions:
- The prognostic impact of elevated baseline hs-CRP in AMI patients is most significant in the initial 6 months following PCI.
- High-intensity statin therapy provides sustained clinical benefit, irrespective of baseline hs-CRP levels and inflammatory response duration.
Background:
Elevated high sensitivity C-reactive protein (hs-CRP) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) has prognostic value for future cardiovascular events. This study aimed to ascertain a valid prognostic time-period for predicting cardiovascular outcome based on baseline hs-CRP in AMI patients undergoing successful PCI on statin therapy.
Methods:
Overall, 4410 AMI patients were enrolled from the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry. Participants were divided into groups according to cut-off values of baseline hs-CRP (1.0, 3.0, and 10.0mg/L) and statin therapy intensity. The primary outcome was 36-month major adverse cardiovascular events (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization. The secondary outcome was MACE developed 0-6, 6-12, and 12-36 months after AMI.
Results:
The overall incidence of 36-month MACE was significantly higher as baseline hs-CRP increased (by groups: 8.8% vs. 8.6% vs. 10.7% vs. 15.4%, log-rank p<0.001). The prognostic effect of baseline hs-CRP was mostly confined to the first 6 months after AMI (0-6 months MACE by groups: 1.6% vs. 2.3% vs. 4.3% vs. 6.1%, log-rank p<0.001) and attenuated in high-intensity statin users. Six months after AMI, this prognostic effect of baseline hs-CRP was remarkably reduced (6-12 month MACE by groups: 2.4% vs. 2.1% vs. 2.8% vs. 4.0%, log-rank p=0.111, 12-36 month MACE by groups: 4.7% vs. 4.1% vs. 4.0% vs. 6.2%, log-rank p=0.218); however, high-intensity statin treatment showed a consistent improvement in outcome. The observed time-dependent prognostic effects remained consistent following multivariate analysis.
Conclusions:
The prognostic impact of elevated hs-CRP at baseline was most evident during the first 6 months after AMI; however, the use of high-intensity statin persistently improved the clinical outcome even after the resolution of inflammatory reactions.
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