Related Experiment Video
Updated: Jun 3, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
C-reactive protein levels and outcomes in infarct-related cardiogenic shock: data from the ECLS-SHOCK trial
Tobias Schupp1, Holger Thiele2, Tienush Rassaf3
1Department of Cardiology, Angiology, Hemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
Insights
Higher C-reactive protein (CRP) levels in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) indicate a greater risk of 30-day mortality. Extracorporeal life support (ECLS) did not alter outcomes, regardless of CRP levels.
Area of Science:
- Cardiology
- Critical Care Medicine
- Inflammation Research
Background:
- The role of systemic inflammation, specifically C-reactive protein (CRP) levels, in acute myocardial infarction with cardiogenic shock (AMI-CS) remains unclear.
- Understanding prognostic markers is crucial for managing high-risk cardiovascular events like AMI-CS.
Purpose of the Study:
- To investigate the association between baseline C-reactive protein (CRP) levels and short-term outcomes in patients experiencing AMI-CS.
- To evaluate the prognostic impact of CRP on 30-day all-cause mortality.
- To assess whether extracorporeal life support (ECLS) modifies outcomes based on CRP levels.
Main Methods:
- Analysis of data from the multicentre, randomized ECLS-SHOCK trial (2019-2022).
- Included 371 patients with AMI-CS and available baseline CRP levels.
- Examined the association of CRP tertiles with 30-day all-cause mortality and the effect of ECLS stratified by CRP.
Main Results:
- Patients in the highest CRP tertile (>61.0 mg/L) had a significantly increased risk of 30-day mortality (adjusted OR: 3.54; P=0.001).
- Higher CRP levels were associated with older age and lower rates of resuscitation from cardiac arrest.
- Extracorporeal life support (ECLS) did not improve 30-day mortality, irrespective of baseline CRP levels.
- Incorporating CRP into the IABP-SHOCK II score slightly improved the prediction of 30-day mortality (AUC: 0.74).
Conclusions:
- Elevated C-reactive protein levels are an independent predictor of 30-day mortality in patients with AMI-CS.
- CRP may serve as a valuable biomarker to enhance existing risk stratification scores for AMI-CS patients.
- Current ECLS strategies did not demonstrate a survival benefit in this cohort, regardless of inflammatory status.
Aims:
The impact of systemic inflammation in acute myocardial infarction complicated by cardiogenic shock (AMI-CS) is still a matter of debate. The present ECLS-SHOCK sub-study investigates the association of C-reactive protein (CRP) levels with short-term outcomes in patients with AMI-CS.
Methods And Results:
Patients with AMI-CS enrolled in the multicentre, randomized ECLS-SHOCK trial between 2019 and 2022 were included. The prognostic impact of CRP levels on admission, as well as the effect of extracorporeal life support (ECLS), stratified by CRP levels, was tested with regard to the primary endpoint of 30-day all-cause mortality. In 371 patients with AMI-CS and available CRP level on baseline, the median CRP level was 18.0 mg/L. Patients with CRP levels in the highest tertile were older and less often resuscitated from cardiac arrest. The highest tertile (i.e. CRP >61.0 mg/L) was associated with an increased risk of 30-day all-cause mortality compared with patients with lower CRP levels (lowest tertile: ≤5.0 mg/L) [adjusted odds ratio: 3.54; 95% confidence interval (CI) 1.88-6.68; P = 0.001]. The use of ECLS did not reduce 30-day all-cause mortality, irrespective of CRP levels on admission. The additional inclusion of CRP to the IABP-SHOCK II score was associated with a slight improvement of the prediction of 30-days all-cause mortality (area under the curve: 0.74; 95% CI 0.68-0.79).
Conclusion:
Higher CRP levels were independently associated with the risk of 30-day all-cause mortality in AMI-CS. The additional inclusion of CRP to a validated CS risk score may further improve the prediction of short-term prognosis.
More Related Videos
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...