Relationship of Serial High-Sensitivity C-Reactive Protein Changes to Long-term Clinical Outcomes in Stabilised Patients After Myocardial Infarction

Myunhee Lee, Kyusup Lee, Dae Won Kim, Jung Sun Cho, Tae Seok Kim, Jongbum Kwon, Chan Joon Kim, Chul Soo Park, Hee Yeol Kim, Ki Dong Yoo, Doo Soo Jeon, Kiyuk Chang, Min Chul Kim, Myung Ho Jeong, Youngkeun Ahn, Mahn Won Park

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4 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)92-101
Number of pages10
JournalCanadian Journal of Cardiology
Volume38
Issue number1
DOIs
StatePublished - Jan 2022

Bibliographical note

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© 2021 Canadian Cardiovascular Society

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