Inflammation during acute coronary syndromes - Risk of cardiovascular events and bleeding
David Nanchen1, Roland Klingenberg2, Baris Gencer3
1Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland.
Insights
Elevated high-sensitivity C-reactive protein (hsCRP) levels during acute coronary syndromes (ACS) predict a higher risk of major adverse cardiovascular events (MACE) within one year. However, hsCRP levels did not correlate with an increased risk of bleeding events.
Area of Science:
- Cardiology
- Inflammation Research
- Biomarkers in Cardiovascular Disease
Background:
- Acute coronary syndromes (ACS) involve complex inflammatory processes.
- Numerous factors influence inflammation levels during ACS.
- Understanding prognostic markers is crucial for patient management.
Purpose of the Study:
- To evaluate the one-year risk of major adverse cardiovascular events (MACE) associated with elevated high-sensitivity C-reactive protein (hsCRP) levels in ACS patients.
- To assess the relationship between hsCRP levels and bleeding events in the same patient cohort.
- To account for myocardial infarction severity, blood sampling timing, and established prognostic factors.
Main Methods:
- Prospective cohort study of 1864 consecutive ACS patients in Switzerland.
- hsCRP levels measured at hospital admission.
- One-year follow-up for MACE and bleeding events; multivariable Cox proportional hazards models used.
Main Results:
- 151 patients (8.1%) experienced MACE at one year.
- Higher hsCRP levels correlated with increased MACE risk: HR 1.63 (2-5 mg/l), HR 2.80 (5-10 mg/l), HR 2.23 (>10 mg/l) compared to <2 mg/l.
- No significant difference in bleeding risk was observed across hsCRP groups.
Conclusions:
- Systemic inflammation during the acute phase of myocardial infarction is an independent predictor of cardiovascular events.
- hsCRP elevation in ACS is a significant prognostic marker for future cardiovascular events.
- hsCRP levels do not predict bleeding risk in ACS patients.
Background:
Many parameters can affect the level of inflammation during acute coronary syndromes (ACS). We aimed to assess the one-year risk of major adverse cardiovascular events (MACE) and bleeding associated with elevated hsCRP levels during ACS, taking into account the severity of myocardial infarction, the timing of blood sampling and established long-term prognostic factors.
Methods:
We studied 1864 consecutive patients with ACS enrolled in a contemporary multicenter prospective cohort study in Switzerland. HsCRP levels were determined at hospital admission. One year after discharge MACE and bleeding events were assessed. Multivariable adjusted Cox proportional hazards were computed with age, sex, time from symptom onset to blood draw, body mass index, current smoking, hypertension, diabetes mellitus, pre-existing cardiovascular disease, history of inflammatory disease, LDL-cholesterol levels, type of ACS, left ventricular ejection fraction and GRACE 1.0 risk score.
Results:
At one-year follow-up, 151 (8.1%) patients suffered MACE. Compared to patients with hsCRP below 2 mg/l, the risk of MACE was higher in patients with hsCRP levels between 2 and 5 mg/l, with a multivariate adjusted hazard ratio (HR) of 1.63 (95% confidence interval (CI) 0.93-2.84), in those with levels between 5 and 10 mg/l, with a HR of 2.80 (95% CI 1.58-4.96), and in those with levels above 10 mg/l, with a HR of 2.23 (95% CI 1.28-3.88). There was no difference in bleeding risk between the four groups.
Conclusions:
Systemic inflammation in the acute phase of myocardial infarction is an independent predictor for cardiovascular events, but not for bleeding.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:26Acute Coronary Syndrome V: Nursing Management
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:38Inflammation