Association of peak C-reactive protein with long-term clinical outcomes in patients with ST-segment elevation
Yoichi Hori1, Kenichi Sakakura2, Hiroyuki Jinnouchi1
1Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
Insights
High peak C-reactive protein (CRP) levels after ST-segment elevation myocardial infarction (STEMI) are linked to increased long-term all-cause death. This finding suggests peak CRP can help identify high-risk STEMI patients for closer monitoring.
Area of Science:
- Cardiology
- Biomarkers
- Clinical Research
Background:
- Peak C-reactive protein (CRP) levels post-ST-segment elevation myocardial infarction (STEMI) correlate with adverse events like left ventricular thrombus and cardiac rupture.
- The long-term prognostic impact of peak CRP levels in STEMI patients remains incompletely understood.
Purpose of the Study:
- To investigate the association between high peak CRP levels and long-term all-cause mortality in patients following STEMI.
- To compare long-term survival rates between STEMI patients with high versus low-moderate peak CRP levels.
Main Methods:
- A retrospective study involving 594 STEMI patients, categorized into high CRP (n=119) and low-moderate CRP (n=475) groups based on peak CRP quintiles.
- Primary endpoint: all-cause death post-discharge. Follow-up duration: median 1045 days.
- Statistical analyses included Kaplan-Meier curves and multivariate Cox hazard analysis to assess the association between peak CRP and mortality, controlling for confounders.
Main Results:
- The high CRP group exhibited a significantly higher mean peak CRP level (19.66 mg/dL) compared to the low-moderate CRP group (6.43 mg/dL) (p < 0.001).
- All-cause death occurred more frequently in the high CRP group (p = 0.002).
- Multivariate analysis confirmed high peak CRP as a significant predictor of all-cause death (Hazard Ratio: 2.325, 95% CI: 1.246-4.341, p = 0.008).
Conclusions:
- Elevated peak C-reactive protein levels are significantly associated with increased long-term all-cause mortality in patients with ST-segment elevation myocardial infarction.
- Peak CRP levels may serve as a valuable biomarker for risk stratification in STEMI patients, identifying individuals at higher risk of future death.
Abstract:
Peak C-reactive protein (CRP) levels following ST-segment elevation myocardial infarction (STEMI) are associated with left ventricular thrombus formation or cardiac rupture. However, the impact of peak CRP on long-term outcomes in patients with STEMI is not completely understood. The purpose of this retrospective study was to compare the long-term all-cause death after STEMI between patients with and without high peak CRP levels. We included 594 patients with STEMI, and divided them into the high CRP group (n = 119) and the low-moderate CRP group (n = 475) according to the quintile of peak CRP levels. The primary endpoint was all-cause death after the discharge of the index admission. The mean peak CRP level was 19.66 ± 5.14 mg/dL in the high CRP group, whereas that was 6.43 ± 3.86 mg/dL in the low-moderate CRP group (p < 0.001). During the median follow-up duration of 1045 days (Q1 284 days, Q3 1603 days), a total of 45 all-cause deaths were observed. The Kaplan-Meier curves showed that all-cause death was more frequently observed in the high CRP group than in the low-moderate CRP group (p = 0.002). The multivariate Cox hazard analysis revealed that high CRP was significantly associated with all-cause death (hazard ratio 2.325, 95% confidence interval 1.246-4.341, p = 0.008) after controlling for confounding factors. In conclusion, high peak CRP was significantly associated with all-cause death in patients with STEMI. Our results suggest that peak CRP may be useful to stratify patients with STEMI for the risk of future death.
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