The c- reactive protein to troponin ratio enhances the differentiation of perimyocarditis from acute myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Differentiating perimyocarditis from acute myocardial infarction (AMI) is frequently difficult . Perimyocarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We surmised that the CRP/troponin ratio on presentation could improve the differentiation between these two clinical entities. We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large hospital registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed as perimyocarditis. CRP and troponin were sampled on admission and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of perimyocarditis against STEMI with or without NSTEMI. Median admission CRP/troponin ratios were 84, 65, and 436 mg × ml/liter × ng in STEMI, NSTEMI and perimyocarditis groups, respectively (p < 0.001) demonstrating good differentiating capability. The ROC of admission CRP/troponin ratio for diagnosis of perimyocarditis against STEMI with or without NSTEMI yielded a similar AUC of 0.74 and 0.73, respectively. CRP/troponin ratio > 500 resulted in specificity exceeding 85%. The CRP/troponin ratio is an effective tool that enhances the differentiation between perimyocarditis and AMI.

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Differentiation between myopericarditis and acute myocardial infarction on presentation in the emergency department using the admission C-reactive protein to troponin ratio

PLoS ONE ◽

10.1371/journal.pone.0248365 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0248365

Author(s):

Simcha R. Meisel ◽

Hamuda Nashed ◽

Randa Natour ◽

Rami Abu Fanne ◽

Majdi Saada ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Emergency Department ◽

Roc Analysis ◽

Area Under The Curve ◽

C Reactive Protein ◽

Reactive Protein ◽

St Elevation ◽

Operator Curve ◽

Median Admission

Background The treatment of myopericarditis is different than that of acute myocardial infarction (AMI). However, since their clinical presentation is frequently similar it may be difficult to distinguish between these entities despite a disparate underlying pathogenesis. Myopericarditis is primarily an inflammatory disease associated with high C-reactive protein (CRP) and relatively low elevated troponin concentrations, while AMI is characterized by the opposite. We hypothesized that evaluation of the CRP/troponin ratio on presentation to the emergency department could improve the differentiation between these two related clinical entities whose therapy is different. Such differentiation should facilitate triage to appropriate and expeditious therapy. Methods We evaluated the CRP/troponin ratio on presentation among patients consecutively included in a large single center registry that included 1898 consecutive patients comprising 1025 ST-elevation myocardial infarction (STEMI) patients, 518 Non-STEMI (NSTEMI) patients, and 355 patients diagnosed on discharge as myopericarditis. CRP and troponin were sampled on admission in all patients and their ratio was assessed against discharge diagnosis. ROC analysis of the CRP/troponin ratios evaluated the diagnostic accuracy of myopericarditis against all AMI, STEMI, and NSTEMI patients. Results Median admission CRP/troponin ratios were 84, 65, and 436 mg×ml/liter×ng in STEMI, NSTEMI and myopericarditis groups, respectively (p<0.001) demonstrating good differentiating capability. The Receiver-operator-curve of admission CRP/troponin ratio for diagnosis of myopericarditis against all AMI, STEMI, and NSTEMI patients yielded an area-under-the curve of 0.74, 0.73, and 0.765, respectively. CRP/troponin ratio>500 resulted in specificity exceeding 85%, and for a ratio>1000, specificity>92%. Conclusion The CRP/troponin ratio can serve as an effective tool to differentiate between myopericarditis and AMI. In the appropriate clinical context, the CRP/troponin ratio may preclude further evaluation.

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Paraoxonase-1 55 LL Genotype Is Associated with No ST-Elevation Myocardial Infarction and with High Levels of Myoglobin

Journal of Lipids ◽

10.1155/2012/601796 ◽

2012 ◽

Vol 2012 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Francesca Marchegiani ◽

Liana Spazzafumo ◽

Maurizio Cardelli ◽

Mauro Provinciali ◽

Francesco Lescai ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Troponin I ◽

Paraoxonase 1 ◽

Ischemic Damage ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome ◽

St Elevation ◽

Serum Paraoxonase

It is well known that serum paraoxonase (PON1) plays an important role in the protection of LDL from oxidation. PON1 55 polymorphism is currently investigated for its possible involvement in cardiovascular diseases. The objective of our study is to verify if PON1 55 polymorphism is associated with risk of acute coronary syndrome (ACS) and with biochemical myocardial ischemia markers, such as troponin I, creatine kinase (CK)-MB, myoglobin, and C-reactive protein. We analysed PON1 55 polymorphism in a total of 440 elderly patients who underwent an ACS episode: 98 patients affected by unstable angina (UA), 207 AMI (acute myocardial infarction) patients affected by STEMI (ST elevation), and 135 AMI patients affected by NSTEMI (no ST elevation). We found that individuals carrying PON1 55 LL genotype are significantly more represented among AMI patients affected by NSTEMI; moreover, the patients carrying LL genotype showed significantly higher levels of myoglobin in comparison to LM + MM carriers patients. Our study suggests that PON1 55 polymorphism could play a role in the pathogenesis of cardiac ischemic damage. In particular, the significant association between PON1 55 LL genotype and the occurrence of a NSTEMI may contribute to improve the stratification of the cardiovascular risk within a population.

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C-reactive protein velocity predicts microvascular pathology after acute ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehab724.0215 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Holzknecht ◽

C Tiller ◽

M Reindl ◽

I Lechner ◽

F Troger ◽

...

Keyword(s):

Myocardial Infarction ◽

Troponin T ◽

Area Under The Curve ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

C Reactive Protein ◽

Reactive Protein ◽

Funding Sources ◽

St Elevation ◽

The Difference

Abstract Background The role of C-reactive protein velocity (CRPv) as an early and sensitive marker of an excessive inflammatory response in the setting of acute ST-elevation myocardial infarction (STEMI) is only poorly understood. Purpose The aim of this study was to investigate, in patients with STEMI treated with primary percutaneous coronary intervention (PCI), the association of CRPv with microvascular infarct pathology. Methods This prospective cohort study included a total of 316 patients with STEMI undergoing PCI. CRPv was defined as the difference between CRP 24±8h and CRP at hospital admission, divided by the time (in h) that have passed during the two examinations. The association of biomarker levels with cardiac magnetic resonance (CMR)-determined microvascular obstruction (MVO) was evaluated. CMR was performed at a median of 3 [interquartile range 2–4] days after PCI. Results After adjustment for cardiac troponin T (cTnT), culprit lesion location and TIMI-flow post-PCI, CRPv (odds ratio 3.36, 95% confidence interval (CI) 1.72–6.57; p<0.001) remained significantly associated with the occurrence of MVO. CRPv (area under the curve [AUC] 0.76, 95% CI 0.71–0.81; p<0.001) was a better predictor for MVO compared to 24h CRP (AUC difference: 0.03, p=0.002). The addition of CRPv to peak cTnT resulted in a higher AUC for MVO prediction than peak cTnT alone (AUC 0.86, 95% CI 0.82–0.90; p<0.001 vs. AUC 0.84, 95% CI 0.79–0.88; p<0.001. AUC difference: 0.02, p=0.042). Conclusions In patients with STEMI treated with primary PCI, CRPv was associated with microvascular infarct pathology with a predictive value incremental to cTnT, suggesting CRPv as an early and sensitive biomarker for more severe infarct pathology and outcome. FUNDunding Acknowledgement Type of funding sources: None. ROC analysis for the prediction of MVO. CRPv (median) and clinical outcome.

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Prognostic Usefulness of Serial C-Reactive Protein Measurements in ST-Elevation Acute Myocardial Infarction

The American Journal of Cardiology ◽

10.1016/j.amjcard.2012.08.041 ◽

2013 ◽

Vol 111 (1) ◽

pp. 26-30 ◽

Cited By ~ 13

Author(s):

Stamatis S. Makrygiannis ◽

Olga S. Ampartzidou ◽

Michael N. Zairis ◽

Nikolaos G. Patsourakos ◽

Christos Pitsavos ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

C Reactive Protein ◽

Reactive Protein ◽

St Elevation ◽

Elevation Acute Myocardial Infarction

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The Role of High-sensitivity C-reactive Protein Serum in Assessing Troponin T in Acute Myocardial Infarction

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.5495 ◽

2020 ◽

Vol 8 (B) ◽

pp. 1053-1056

Author(s):

Taufik Indrajaya ◽

Mgs Irsan Saleh ◽

Miliyandra Miliyandra

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Likelihood Ratio ◽

Troponin T ◽

High Sensitivity ◽

C Reactive Protein ◽

Reactive Protein ◽

Coronary Syndrome ◽

St Elevation ◽

Hs Crp

BACKGROUND: The incidence of acute myocardial infarction (AMI) is increasing worldwide. Inflammation plays an essential role in the initiation and progression of atherosclerosis and the pathogenesis of acute cardiovascular events. C-reactive protein (CRP) has been shown to have prognostic value in patients with acute coronary syndrome, but the most promising use of CRP has been used for primary use. AIM: This study was aimed to explore the sensitivity of high-sensitivity CRP (hs-CRP) in assessing troponin T in AMI. METHODS: The study design was an observational study to assess the sensitivity and specificity of hsCRP against troponin T in patients with AMI with ST-elevation and without ST-elevation. This research was conducted in Palembang, Indonesia. The study subjects were 56 patients with an acute myocardial infusion that met the inclusion and exclusion criteria. RESULTS: The sensitivity of hs-CRP to troponin-T is 93.7%. The specificity of hs-CRP to troponin T was 37.5%. The positive suspected value is 0.9, the estimated negative value is 0.5, the positive likelihood ratio is 1.49, and the negative likelihood ratio is 0.16. CONCLUSION: hs-CRP is quite sensitive in assessing troponin-T but not specific enough in assessing troponin-T activity.

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