Subject(s)
Angina, Unstable/blood , Angina, Unstable/diagnosis , C-Reactive Protein/analysis , Electrocardiography, Ambulatory/methods , Aged , Analysis of Variance , Biomarkers/blood , Blood Chemical Analysis , Cohort Studies , Female , Humans , Logistic Models , Male , Middle Aged , Monitoring, Physiologic/methods , Multivariate Analysis , Myocardial Infarction/blood , Myocardial Infarction/diagnosis , Predictive Value of Tests , Probability , Prognosis , Prospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Statistics, NonparametricABSTRACT
BACKGROUND: High plasma C-reactive protein (CRP) levels have been associated with an unfavorable outcome in patients with coronary artery disease (CAD), and a direct participation of CRP in the atherosclerotic process has been postulated. HYPOTHESIS: The aim of this study was to evaluate the possible relationship of high plasma CRP levels with the rapid progression of coronary atherosclerosis (RPCAD). METHODS: In all, 194 patients who were readmitted and underwent repeat coronary angiography because of recurrence of symptoms following successful percutaneous coronary intervention were studied. Median angiographic follow-up time was 6 months. Rapid progression CAD was defined as the presence of a new lesion, > 25% in luminal diameter stenosis, in a previously nondiseased vessel, or deterioration of a known, nontreated lesion by at least 25%. RESULTS: By multivariate analysis, patients with high plasma CRP levels upon first admission were at higher risk of RPCAD. In particular, odds ration (OR) = 1.8; 95% confidence interval (CI) = 1.3-3.6; p value = 0.02 in patients with CRP = 0.5-2 mg/dl versus patients with CRP < 0.5 mg/dl, and OR = 7.1; 95% CI = 3.8-9.5; p value < 0.001 in patients with CRP > 2 mg/dl versus patients with CRP < 0.5 mg/dl. CONCLUSION: Increased plasma CRP levels could possibly identify patients at high risk for the development of RPCAD.
Subject(s)
C-Reactive Protein/analysis , Coronary Disease/blood , Aged , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Disease/diagnostic imaging , Coronary Disease/therapy , Disease Progression , Female , Humans , Male , Middle Aged , Multivariate Analysis , Risk Assessment , Risk FactorsABSTRACT
BACKGROUND: Several studies have shown the independent association of high plasma C-reactive protein (CRP) levels with an adverse prognosis in patients with acute myocardial infarction. However, the possible association of plasma CRP levels with response to thrombolysis and short- and long-term cardiac mortality has not been investigated. The aim of this study was to evaluate these possible associations. METHODS: Three hundred nineteen consecutive patients who received intravenous thrombolysis because of ST-segment elevation acute myocardial infarction were prospectively studied. Patients were classified according to tertiles of plasma CRP levels on admission. RESULTS: Patients at the top tertile had a significantly lower incidence of complete ST-segment resolution (third vs first, P <.001, third vs second, P =.009) or Thrombolysis In Myocardial Infarction (TIMI) 3 flow in the infraction-related artery (third vs first, P <.001, third vs second, P =.02), more compromised left ventricular function (third vs first, P =.02, second vs third, P =.04), greater inhospital mortality (third vs first, P =.03, third vs second, P =.06), and greater 3-year cardiac mortality (third vs first, P =.01, third vs second, P =.07). CONCLUSIONS: Plasma levels of CRP on admission may be a predictor of reperfusion failure and of short- and long-term prognosis in patients with ST-segment elevation acute myocardial infarction.
Subject(s)
C-Reactive Protein/analysis , Myocardial Infarction/blood , Myocardial Infarction/drug therapy , Thrombolytic Therapy , Analysis of Variance , Biomarkers/blood , Female , Hospital Mortality , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Prospective Studies , Survival Analysis , Treatment FailureABSTRACT
OBJECTIVES: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS). BACKGROUND: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited. METHODS: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion (