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High sensitivity C-reactive protein is associated with worse infarct healing after revascularized ST-elevation
Christina Tiller1, Martin Reindl1, Magdalena Holzknecht1
1University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Insights
High-sensitivity C-reactive protein (hs-CRP) levels after ST-elevation myocardial infarction (STEMI) correlate with improved infarct healing. This suggests inflammation plays a key role in heart attack recovery and long-term outcomes.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation Research
Background:
- Myocardial infarction triggers an inflammatory response crucial for healing, but excessive inflammation can worsen damage.
- Understanding the role of systemic inflammatory biomarkers in infarct healing is vital for STEMI patients.
Purpose of the Study:
- To investigate the association between systemic inflammatory biomarkers and infarct size (IS) dynamics post-STEMI.
- To assess how biomarkers like hs-CRP, WBCc, and fibrinogen relate to infarct healing over four months.
Main Methods:
- Prospective observational study of 245 STEMI patients undergoing primary PCI.
- Serial measurements of hs-CRP, WBCc, and fibrinogen up to 96 hours post-PCI.
- Infarct healing assessed by relative IS reduction using CMR imaging at 4 months.
Main Results:
- Significant reduction in IS from 16% to 10% of LVM at 4 months (p < 0.001).
- Peak hs-CRP levels were significantly associated with relative IS reduction (p = 0.003).
- Peak WBCc and fibrinogen showed no significant association with IS reduction.
Conclusions:
- hs-CRP is independently associated with infarct size reduction in STEMI patients treated with pPCI.
- Findings suggest a link between inflammation and infarct healing processes in STEMI survivors.
- hs-CRP may serve as a prognostic marker for infarct healing post-STEMI.
Background:
The inflammatory response due to myocardial tissue injury in the setting of acute ST-elevation myocardial infarction (STEMI) is essential for proper local infarct healing. However, an excessive inflammatory response may aggravate myocardial damage and hampers infarct healing processes. The present study aimed to investigate the association of systemic inflammatory biomarkers with infarct size (IS) dynamics post-STEMI, using cardiac magnetic resonance (CMR) imaging.
Methods:
This prospective observational study included 245 STEMI patients treated with primary percutaneous coronary intervention (pPCI). Peak values of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc) and fibrinogen were determined serially until 96 h after pPCI. Infarct healing, defined as relative IS reduction from baseline to 4 months after STEMI, was assessed using late gadolinium enhanced CMR imaging.
Results:
IS significantly decreased from 16% of left ventricular mass (LVM) (Interquartile range [IQR]:8-24) at baseline to 10% (IQR:5-17) at 4 months (p < 0.001). Relative IS reduction was 35% (IQR:8-50). Whereas peak WBCc (p = 0.926) and peak fibrinogen (p = 0.161) were not significantly associated with relative IS reduction, peak hs-CRP showed a significant association with IS reduction (p = 0.003). In multivariable logistic regression analysis, the association between peak hs-CRP and relative IS reduction remained significant after adjustment for baseline IS, hypertension, hs-cardiac troponin T and N-terminal pro B-type natriuretic peptide (odds ratio:0.35 [95% confidence interval:0.19-0.63]; p = 0.001).
Conclusions:
In STEMI patients treated with pPCI, hs-CRP was independently associated with 4 months IS reduction as determined by CMR, suggesting a pathophysiological interplay between inflammation and adverse infarct healing in survivors of acute STEMI.
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