Acute phase reactant CRP and ESR versus cardiac enzymes in evaluation of the extent of active coronary artery disease [unstable angina and acute myocardial infarction]

ABSTRACT

Acute phase reactant C-reactive protein [CRP] and the erythrocyte sedimentation rate [ESR] are expected to rise during the course of active coronary artery disease [CAD] [unstable angina [UA] and acute myocardial infarction [M.I.] as an inflammatory process has been proposed to be involved in the pathogenesis of both conditions. Our aim of this study was to evaluate the kinetics of rise of CRP and ESR and their correlation with the pattern of changes of cardiac enzymes [creation phospokinase [CPK], lactic dehydrognase [LDH] and serum glumatic oxalacetic transferase [SGOT] in active CAD. 50 patients [pts] with active CAD were studied [17 pts with UA [gp. I]; including 12 males and 5 females with a mean age of 53.4 +/- 7y and 33 pts with acute M.I. [gp. II]; including 24 males and 4 females with a mean age of 54.2 +/- 11y. The mean CRP and ESR were elevated in gpi [2.12 +/- 1.12 mg/dl and 58.7 +/- 33 mm/h respectively with the serial cardiac enzymes [CPK, LDH and SGOT] were within normal limits. Gp II revealed marked elevations of the cardiac enzymes [CPK ranged from 202-1800 IU/L with a mean of 774 +/- 448 while the mean peak LDH was 1093 +/- 400 IU/L [315-2080 IU/L] mean SGOT was 157 +/- 98 U/L [20-400 U/L]. Serum CRP was significantly elevated ranged 6-24 mg/dl with a mean of 18 +/- 5.6 mg/dl and the mean ESR was 83 +/- 33 mm/h ranged from 25-140 mm/h]. For CRP the mean time to peak was 3.15 +/- 0.69 and mean time to disappear was 8.53 +/- 0.91 d after the onset of chest pain. Strong correlation was found between mean CRP and Mean CPK [r=0.5]. Also, Significant difference was found between peak CPK in pts with anterior and inferior M.I. [p> 0.05]. We conclude that The concentration of CRP rapidly in response to tissue injury [acute M.I.] with a peak level at a mean time of 60 hours after chest pain, falls to normal after 7 days in uncomplicated cases. A significant correlation was found between CPK, CRP and ESR as indices of severity in pts suffering from acute M.I. A positive CRP test is a valuable aid in establishing the presence of irreversible injury and the more the area of myocardial necrosis, the more prolonged the production and the persistence of the postulated mediato