Prediction of heart failure by C-reactive protein in patients with acute myocardial infarction

Introduction

Inflammatory markers such as C-reactive protein (CRP) have shown a high prognostic value in the setting of coronary artery disease and heart failure (HF).

Hypothesis

To correlate CRP levels in patients admitted with acute myocardial infarction (AMI) with MACE, presence of pulmonary congestion, ventricular function by echocardiogram, and inhospital (IH) mortality.

Methods

A prospective cohort of 222 patients (72% male, 64 ± 13 years old) were admitted to a tertiary hospital coronary care unit after an AMI and were treated with primary percutaneous coronary intervention (PCI) between March 1999 and October 2003, and were followed for 31.5 ± 15.3 months. The door to balloon time (DB) was 322 ± 908 min, 70.2% underwent stent placement and 70.2% were Killip I class. CRP was measured in 91 patients at baseline (CRP1) and 24 hours after PCI (CRP2), and Delta PCRt was defined by CRP1 – CRP2. The Mann–Whitney and Wilcoxon tests were performed and statistical significance was defined as P ≤ 0.05.

Results

Higher levels of CRP2 were correlated with higher DB (P = 0.03) and diabetes (P = 0.037). There was no correlation between the values of CRP-b and CRP-24 hours and MACE. Higher values of Delta PCRt were correlated with age, Killip class II/III and the presence of left ventricular dysfunction, as well as inhospital mortality. ROC curve analysis (AUC = 0.747; 95% CI = 0.602–0.691) correlated Delta CRP and inhospital mortality. The best Delta PCRt cutoff was 2.32 mg/dl to predict inhospital mortality.

Conclusion

CRP variation in the first 24 hours seems to be a relevant method to predict HF in patients admitted with AMI.