TY - JOUR
T1 - Relationship of Serial High-Sensitivity C-Reactive Protein Changes to Long-term Clinical Outcomes in Stabilised Patients After Myocardial Infarction
AU - Lee, Myunhee
AU - Lee, Kyusup
AU - Kim, Dae Won
AU - Cho, Jung Sun
AU - Kim, Tae Seok
AU - Kwon, Jongbum
AU - Kim, Chan Joon
AU - Park, Chul Soo
AU - Kim, Hee Yeol
AU - Yoo, Ki Dong
AU - Jeon, Doo Soo
AU - Chang, Kiyuk
AU - Kim, Min Chul
AU - Jeong, Myung Ho
AU - Ahn, Youngkeun
AU - Park, Mahn Won
N1 - Publisher Copyright:
© 2021 Canadian Cardiovascular Society
PY - 2022/1
Y1 - 2022/1
N2 - Background: Little is known about the association between serial high-sensitivity C-reactive protein (hsCRP) measurements and long-term outcomes in post–myocardial infarction (MI) patients. We aimed to investigate the usefulness of serial hsCRP measurements for risk stratification in stabilised post-MI patients after percutaneous coronary intervention (PCI). Methods: A total of 1018 patients who had hsCRP values at both baseline and 1 year after MI were included. High inflammatory status was defined as hsCRP > 2 mg/L. Patients were classified into 4 groups: persistently low, falling (first high then low hsCRP), rising (first low then high hsCRP), and persistently high hsCRP. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause of death, MI, and cerebrovascular accident) within 4 years after the second hsCRP measurement. Results: At 1 year after MI, the numbers of patients in the persistently low, falling, rising, and persistently high hsCRP groups were 394 (38.7%), 358 (35.2%), 69 (6.8%), and 197 (19.4%), respectively. The incidence of MACCE was progressively elevated from the persistently low to the falling, rising, and persistently high hsCRP groups (4.8%, 8.1%, 10.1%, and 13.2%, respectively; P = 0.004). Persistently high hsCRP was an independent predictor of MACCE (adjusted hazard ratio 2.55; 95% confidence interval 1.35-4.81; P = 0.004) and provided incremental prognostic value beyond that of the baseline clinical risk model (net reclassification improvement = 0.397; integrated discrimination improvement = 0.025; all P < 0.001). Conclusions: Among stabilised post-MI patients who underwent PCI, persistently high hsCRP was frequently seen 1 year after MI and was strongly associated with long-term adverse clinical outcomes. Serial measurements of hsCRP during clinical follow-up after MI may help to identify patients at higher risk for mortality and morbidity.
AB - Background: Little is known about the association between serial high-sensitivity C-reactive protein (hsCRP) measurements and long-term outcomes in post–myocardial infarction (MI) patients. We aimed to investigate the usefulness of serial hsCRP measurements for risk stratification in stabilised post-MI patients after percutaneous coronary intervention (PCI). Methods: A total of 1018 patients who had hsCRP values at both baseline and 1 year after MI were included. High inflammatory status was defined as hsCRP > 2 mg/L. Patients were classified into 4 groups: persistently low, falling (first high then low hsCRP), rising (first low then high hsCRP), and persistently high hsCRP. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE: a composite of all-cause of death, MI, and cerebrovascular accident) within 4 years after the second hsCRP measurement. Results: At 1 year after MI, the numbers of patients in the persistently low, falling, rising, and persistently high hsCRP groups were 394 (38.7%), 358 (35.2%), 69 (6.8%), and 197 (19.4%), respectively. The incidence of MACCE was progressively elevated from the persistently low to the falling, rising, and persistently high hsCRP groups (4.8%, 8.1%, 10.1%, and 13.2%, respectively; P = 0.004). Persistently high hsCRP was an independent predictor of MACCE (adjusted hazard ratio 2.55; 95% confidence interval 1.35-4.81; P = 0.004) and provided incremental prognostic value beyond that of the baseline clinical risk model (net reclassification improvement = 0.397; integrated discrimination improvement = 0.025; all P < 0.001). Conclusions: Among stabilised post-MI patients who underwent PCI, persistently high hsCRP was frequently seen 1 year after MI and was strongly associated with long-term adverse clinical outcomes. Serial measurements of hsCRP during clinical follow-up after MI may help to identify patients at higher risk for mortality and morbidity.
UR - http://www.scopus.com/inward/record.url?scp=85121672402&partnerID=8YFLogxK
U2 - 10.1016/j.cjca.2021.10.007
DO - 10.1016/j.cjca.2021.10.007
M3 - Article
C2 - 34737035
AN - SCOPUS:85121672402
SN - 0828-282X
VL - 38
SP - 92
EP - 101
JO - Canadian Journal of Cardiology
JF - Canadian Journal of Cardiology
IS - 1
ER -