High sensitivity C-reactive protein is associated with worse infarct healing after revascularized ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Tiller ◽  
M Reindl ◽  
M Holzknecht ◽  
I Lechner ◽  
F Simma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Inflammatory Response ◽  
High Sensitivity ◽  
Funding Source ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Infarct Healing ◽  
St Elevation ◽  
Hs Crp ◽  
Cmr Imaging

Abstract Background The inflammatory response due to myocardial tissue injury in the setting of acute ST-elevation myocardial infarction (STEMI) is essential for proper local infarct healing. However, an excessive inflammatory response may aggravate myocardial damage and hampers infarct healing processes. The present study aimed to investigate the association of systemic inflammatory biomarkers with infarct size (IS) dynamics post-STEMI, using cardiac magnetic resonance (CMR) imaging. Methods This prospective observational study included 245 STEMI patients treated with primary percutaneous coronary intervention (pPCI). Peak values of high-sensitivity C-reactive protein (hs-CRP), white blood cell count (WBCc) and fibrinogen were determined serially until 96 hours after pPCI. Infarct healing, defined as relative IS reduction from baseline to 4 months after STEMI, was assessed using late gadolinium enhanced CMR imaging. Results IS significantly decreased from 16% of left ventricular mass (LVM) (Interquartile range [IQR]:8–24) at baseline to 10% (IQR:5–17) at 4 months (p<0.001). Relative IS reduction was 35% (IQR:8–50). Whereas peak WBCc (p=0.926) and peak fibrinogen (p=0.161) were not significantly associated with relative IS reduction, peak hs-CRP showed a significant association with IS reduction (p=0.003). In multivariable logistic regression analysis, the association between peak hs-CRP and relative IS reduction remained significant after adjustment for baseline IS, hypertension, hs-cardiac troponin T and N-terminal pro B-type natriuretic peptide (odds ratio:0.35 [95% confidence interval:0.19–0.63]; p=0.001). Conclusions In STEMI patients treated with pPCI, hs-CRP was independently associated with 4 months IS reduction as determined by CMR, suggesting a pathophysiological interplay between inflammation and adverse infarct healing in survivors of acute STEMI. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Austrian Society of Cardiology

Abstract 346: Platelet Reactivity to Aspirin and Clopidogrel in Patients with Acute ST Elevation Myocardial Infarction and its Correlation with High Sensitivity C- Reactive Protein

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
Archana Rajdev ◽  
Oana Penciu ◽  
Jacqueline Bradley ◽  
Cristina Mihu ◽  
Alan Siqueros ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Platelet Reactivity ◽  
High Sensitivity ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Significant Difference ◽  
St Elevation ◽  
Hs Crp

INTRODUCTION Implantation of bare metal or drug eluting stents supported by dual antiplatelet therapy (DAPT) is standard treatment for the management of patients with ST elevation myocardial infarction (STEMI). Individual response to aspirin and clopidogrel is heterogeneous, and decreased response is associated with thrombotic events following stenting. We postulated that systemic inflammation at the time of STEMI would diminish responsiveness to DAPT. The aim of this study is to evaluate the correlation between elevated high-sensitivity C-reactive protein (hs-CRP) as a marker of inflammation and decreased platelet sensitivity to DAPT in STEMI. METHODS We recruited patients with STEMI undergoing percutaneous coronary intervention (PCI) who received oral clopidogrel 600 mg loading dose followed by 75 mg daily maintenance dose and aspirin 325 mg daily. Platelet reactivity and hs-CRP were measured within 72 hours of PCI and at 6 weeks. For patients receiving eptifibatide, blood samples were taken 48 hours after discontinuation. Platelet reactivity was assessed using the VerifyNow platelet function analyzer. A cut-off value of 208 platelet reaction units (PRU) was used to define high on-clopidogrel platelet reactivity (HCPR) and a value of 454 aspirin reaction units (ARU) was used to define high on-aspirin platelet reactivity (HAPR). RESULTS In 20 patients aged 31 to 85, in hospital and 6 weeks after STEMI, hs-CRP was 6.7 (SD 4.0) and 2.6 (SD 3.2) respectively, p< 0.01. Changes in ARU from 408.3 (SD 54.3) to 425.2 (SD 68.2) and PRU from 157.8 (SD 74.7) to 164.2 (SD 75) were not statistically significant. 2 patients had HAPR in hospital; 1 became sensitive at follow up. 2 patients developed HAPR and HCPR. We saw a trend towards higher PRU in diabetic patients and those prescribed statins. CONCLUSIONS Although we found a significant difference in hs-CRP levels between the first and second time point, no significant difference was found in on-aspirin and on-clopidogrel platelet reactivity between the time points.Thus, in this small series, the acute inflammatory state associated with STEMI did not appear to influence the on-DAPT reactivity at the dosages used. Trends among those with diabetics and prescribed statins will be discussed

On-admission Serum High-Sensitivity C-Reactive Protein Level Independently Predicts In-Hospital Mortality and Adverse Cardiovascular Events in ST-elevation Acute Myocardial Infarction

2021 ◽  
pp. 263246362110553
Author(s):  
Anggoro Budi Hartopo ◽  
Indah Sukmasari ◽  
Maria Patricia Inggriani ◽  
Thomas Rikl ◽  
Stefi Geovani Valentin Hayon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Events ◽  
Multivariable Analysis ◽  
High Sensitivity ◽  
Inflammatory Biomarkers ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
St Elevation ◽  
Hs Crp ◽  
Elevation Acute Myocardial Infarction

Background: Inflammatory biomarkers are associated with adverse cardiovascular events during ST-elevation acute myocardial infarction (STEMI). We aimed to investigate the role of inflammatory biomarkers, high-sensitivity C-reactive protein (hs-CRP), and soluble ST-2 (sST2), for prediction of adverse cardiovascular events in STEMI. Methods: This was a prospective cohort study that consecutively enrolled patients with STEMI. Subjects were observed during hospitalization until discharge or fatal events happened. Adverse cardiovascular event was a compilation of cardiac mortality, acute heart failure, cardiogenic shock, reinfarction, and malignant ventricular arrhythmia. Blood samples were withdrawn on admission and inflammatory biomarkers (hs-CRP and sST2) were measured. The receiver operator characteristics curve and multivariable analysis were performed to determine which inflammatory biomarkers predict in-hospital adverse cardiovascular events and mortality. Result: Of 166 subjects, the in-hospital adverse cardiovascular events occurred in 41 subjects (24.6%) and mortality occurred in 16 subjects (9.6%). Subjects with in-hospital adverse cardiovascular events and mortality had a significantly higher hs-CRP level, but comparable sST2 level than subjects without events. The hs-CRP level was the most precise biomarkers to predict in-hospital adverse cardiovascular events (hs-CRP cut-off ≥2.75 mg/L) and mortality (hs-CRP cut-off ≥7 mg/L). Multivariable analysis indicated hs-CRP ≥2.75 mg/L as an independent predictor for in-hospital adverse cardiovascular events (adjusted odds ratio [OR]: 2.79, 95% confidence interval [CI]: 1.05-7.39, P = .039) and hs-CRP ≥7 mg/L for mortality (adjusted OR: 5.45, 95% CI: 1.13-26.18, P = .034) in STEMI. Conclusion: On admission, hs-CRP level independently predicted in-hospital adverse cardiovascular events, at cut-off level ≥2.75 mg/L, and mortality, at cut-off level ≥7 mg/L, in STEMI patients.

scholarly journals Influence of myocardial damage on serum procalcitonin in ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Reindl ◽  
C Tiller ◽  
M Holzknecht ◽  
I Lechner ◽  
B Henninger ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Injury ◽  
Release Kinetics ◽  
Myocardial Damage ◽  
High Sensitivity ◽  
St Elevation Myocardial Infarction ◽  
Funding Source ◽  
St Elevation ◽  
Hs Crp ◽  
Cmr Imaging

Abstract Background Myocardial tissue injury due to acute ST-elevation myocardial infarction (STEMI) initiates an inflammatory response with a release of systemic inflammatory biomarkers including C-reactive protein (CRP) and white blood cell count (WBCc), which, however, hampers the usefulness of these routine biomarkers to identify concomitant infections. The clinical role of Procalcitonin (PCT), a promising marker of bacterial infections, to detect concomitant infections in acute STEMI is unknown, mainly because it is unclear whether myocardial injury per se induces a systemic PCT release. Purpose To investigate release kinetics of serum PCT in the acute setting of STEMI and possible associations with myocardial injury markers as comprehensively assessed by cardiac magnetic resonance (CMR) imaging. Methods In this prospective observational study, we included 141 STEMI patients treated with primary percutaneous coronary intervention (PCI). Concentrations of PCT, high-sensitivity CRP (hs-CRP), WBCc and high-sensitivity cardiac troponin T (hs-cTnT) were measured serially at day 1 and day 2 after infarction. CMR imaging to assess infarct size (IS), extent of microvascular injury (MVI) and occurrence of intramyocardial haemorrhage (IMH) was performed within the first week following STEMI. Results Median concentrations of PCT were 0.07μg/l at both time points. In 140 patients (99%), both PCT values were within the normal range (≤0.5μg/l). Whereas hs-CRP, WBCc, and hs-TnT were significantly correlated with CMR markers of myocardial damage, PCT did not show significant correlations (all p&gt;0.10) with IS (PCT24h: r=0.07; PCT48h: r=0.13) or MVI (PCT24h: r=−0.03; PCT48h: r=0.09). Furthermore, PCT failed to discriminate between large and small IS or MVI or between presence and absence of IMH (AUC values:0.46–0.55). Conclusions In the acute phase after PCI for STEMI, circulating PCT remained unaffected by the extent of myocardial and microvascular tissue damage as visualized by CMR imaging. These data highlight the clinical potential of PCT to identify concomitant infections and to guide antibiotic treatments in STEMI patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Austrian Science Fund, Tiroler Wissenschaftsförderung

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

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.

scholarly journals Anticipation of High-Sensitivity C-Reactive Protein Effect on Post Myocardial Infarction Depression Disorder

2021 ◽  
Vol 10 ◽  
pp. e1512
Author(s):  
Parichehr Alizadeh ◽  
Ehsan Bahramali ◽  
Arvin Hedayati ◽  
Azizallah Dehghan
Keyword(s):  
Myocardial Infarction ◽  
High Sensitivity ◽  
Intima Media Thickness ◽  
Public Health Issue ◽  
C Reactive Protein ◽  
Mild Depression ◽  
Reactive Protein ◽  
Depressed Patients ◽  
Inflammatory State ◽  
Hs Crp

Background: The natural history of acute myocardial infarction (AMI) as the most prevalent public health issue in Iran has changed with the introduction of novel therapeutic strategies that have reduced its mortality significantly. Major depressive disorder (MDD) is a prevalent and disabling psychiatric disorder and frequently co-exist with AMI. There are proposed pathophysiological links between the two diseases among which inflammation is the most important. With more patients surviving a myocardial infarction (MI) event, post-MI depression has become an important determinant of disability and mortality. Materials and Methods: In this study we defined a 1-month post-MI depressive scale of 200 patients using Beck’s inventory questionnaire II and measured serum high Sensitivity C-Reactive Protein (hs-CRP) and carotid intima-media thickness (CIMT) to look for the association between inflammatory state and atherosclerosis in different depression score categories. Results: Minimum and maximum Beck scores were 1 and 43, respectively with a mean of 13±8. The mean CIMT was 0.77±0.26 mm. Serum hs-CRP level was measured with a mean of 1.51±1.6 mg/L. According to BDI-II scores, 44.2% of patients 1-month post-MI suffered from more than mild depression. Being affected was not correlated with either the level of hs-CRP or CIMT. Nearly 44 percent of patients suffered more than mild depression. There was a negative association between serum hs-CRP level and CIMT as a measure of atherosclerosis in groups of depressed versus non-depressed patients. This may indicate that the extent of atherosclerosis is not correlated with the inflammatory state after MI in depressed versus non-depressed patients. Conclusions: The results of this study indicate that the extent of atherosclerosis is not correlated with the inflammatory state after MI in depressed versus non-depressed patients. Nonetheless, the prognostic indications of increased hs-CRP and depression after AMI remains to be investigated further. [GMJ.2021;10:e1512]

scholarly journals High-Sensitivity C-Reactive Protein and Acute Kidney Injury in Patients with Acute Myocardial Infarction: A Prospective Observational Study

2019 ◽  
Vol 8 (12) ◽  
pp. 2192 ◽  
Author(s):  
Nicola Cosentino ◽  
Stefano Genovese ◽  
Jeness Campodonico ◽  
Alice Bonomi ◽  
Claudia Lucci ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Kidney Injury ◽  
Kidney Injury ◽  
High Sensitivity ◽  
Future Research ◽  
Hospital Death ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp

Background. Accumulating evidence suggests that inflammation plays a key role in acute kidney injury (AKI) pathogenesis. We explored the relationship between high-sensitivity C-reactive protein (hs-CRP) and AKI in acute myocardial infarction (AMI). Methods. We prospectively included 2,063 AMI patients in whom hs-CRP was measured at admission. AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema were the study endpoints. Results. Two-hundred-thirty-four (11%) patients developed AKI. hs-CRP levels were higher in AKI patients (45 ± 87 vs. 16 ± 41 mg/L; p < 0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (p for trend <0.0001 for all comparisons). A significant correlation was found between hs-CRP and the maximal increase of serum creatinine (R = 0.23; p < 0.0001). The AUC of hs-CRP for AKI prediction was 0.69 (p < 0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP might prevent AKI and improve outcome.

scholarly journals High Sensitivity C-Reactive Protein sebagai Parameter Diagnostik dan Prediktor Luaran Sepsis pada Anak yang Menderita Systemic Inflammatory Response Syndrome

Sari Pediatri ◽  
2016 ◽  
Vol 16 (4) ◽  
pp. 278
Author(s):  
Sofni Sarmen ◽  
Mayetti Mayetti ◽  
Hafni Bachtiar
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Immunosorbent Assay ◽  
High Sensitivity ◽  
Systemic Inflammatory Response ◽  
Enzyme Linked Immunosorbent Assay ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Hs Crp ◽  
Elisa Data

Latar belakang. Sepsis merupakan salah satu penyebab morbiditas dan mortalitas pada anak. Diagnosissepsis ditegakkan berdasarkan gejala Systemic Inflammatory Response Syndrome (SIRS) dan penemuan bakteripada kultur darah. Kultur bakteri darah memiliki sensitifitas yang rendah dan membutuhkan waktu yanglama sehingga sering menyebabkan terjadinya overdiagnosis dan overtreatment. C-reactive protein adalahreaktan fase akut yang kadarnya meningkat pada keadaan infeksi. High sensitivity C-reactive protein (hs-CRP) adalah metode yang lebih sensitif untuk mengukur kadar CRP dalam jumlah kecil.Tujuan. Mengetahui peran hs-CRP sebagai parameter diagnostik dan prediktor luaran sepsis pada anakyang menderita SIRS.Metode. Penelitian uji diagnostik dengan desain potong lintang terhadap 85 anak dengan gejala SIRS berusia1 bulan sampai dengan 15 tahun dan dirawat di bangsal anak RS.Dr.M.Djamil Padang sejak Juni sampaiNovember 2012. Pemeriksaan hs-CRP dilakukan dengan metode enzyme-linked immunosorbent assay (ELISA).Data dianalisis dengan SPSS serta dilakukan uji diagnostik. Baku emas sepsis adalah biakan darah.Hasil. Cut off point hs-CRP untuk menentukan sepsis adalah 15,55 ng/ml, (sensitivitas 90,9% dan spesivisitas53,8%). Kadar rata-rata hs-CRP meningkat sesuai dengan beratnya penyakit.Kesimpulan. High sensitivity C-reactive protein dapat dijadikan sebagai parameter diagnostik sepsis padapasien SIRS dengan cut off point 15,55 ng/ml, serta dapat dipakai sebagai prediktor luaran sepsis.

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