The present study investigated the association between C-reactive protein (CRP) on
admission independently and in combination with troponin and short-term prognosis
in an unselected sample of patients with acute myocardial infarction (AMI) from the
community. The study population consisted of 1,646 patients aged 25 to 74 years who
were consecutively hospitalized with AMI within 12 hours after symptom onset. They
were divided into the 2 groups of CRP positive (n = 919) or CRP negative (n = 727)
with respect to admission CRP (cutoff ≤0.3 mg/dl). CRP-positive patients had significantly
more in-hospital complications and a higher 28-day case-fatality rate (9.6% vs 3.4%;
p <0.0001). Troponin at admission (n = 1,419) also correlated with 28-day case-fatality
rate (troponin-negative 3.4% vs troponin-positive patients 8.0%; p <0.002). Multivariable
analysis showed that both troponin positivity and CRP positivity were associated with
a 2-fold (adjusted odds ratio 1.99, 95% confidence interval 1.15 to 3.44; adjusted
odds ratio 2.05, 95% confidence interval 1.09 to 3.84, respectively) increased risk
of dying within 28 days after the acute event for all patients with AMI. Stratifying
by AMI type showed that in patients with ST-elevation myocardial infarction (STEMI),
troponin positivity, but not CRP positivity, independently predicted 28-day case fatality.
In patients with non-STEMI, CRP positivity, but not troponin positivity, predicted
outcome. In conclusion, admission CRP was a powerful parameter for risk stratification
of patients with AMI. Stratification by AMI type and troponin showed that CRP was
a better short-term risk predictor for patients with non-STEMI, and troponin was,
for patients with STEMI.
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Article info
Publication history
Published online: August 19, 2008
Accepted:
June 9,
2008
Received in revised form:
June 9,
2008
Received:
May 5,
2008
Footnotes
The Cooperative Health Research in the Region of Augsburg (KORA) research platform and the Monitoring Trends and Determinants on Cardiovascular Diseases (MONICA) Augsburg studies were initiated and supported by the Helmholtz Zentrum München, Germany, German Research Center for Environmental Health, which is supported by the German Federal Ministry of Education, Science, Research and Technology and the State of Bavaria, München, Germany. Since 2000, myocardial infarction data collection is cofinanced by the German Federal Ministry of Health and Social Security, Berlin, Germany (www.gbe-bund.de).
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© 2008 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
