Very Early C-Reactive Protein Levels after Acute Myocardial Infarction Predict Early Outcome and Late Prognosis

Objectives: C-reactive protein (CRP) blood levels are associated with atherosclerosis and increased incidence of coronary events. Aim: To evaluate the utility for risk stratification of very early blood CRP levels, during the first 6 hours after the onset of chest pain, in patients with acute myocardial infarction (AMI). Methods: 118 patients with AMI, 88 men, age 63.3 ± 8 yrs, were evaluated, and CRP was assessed within the first 6 hours after the onset of chest pains. Results: CRP level in all patients was 15.7 ± 14.1 mg/L. Its level increased with higher Killip class, 11.2 ± 5 mg/L in class 1, and 62 ± 7 mg/L in class 4 (p < 0.01), and with lower left ventricular ejection fraction (EF), 32.3 ± 10 mg/L with EF < 30% and 9 ± 4 mg/L with EF > 40% (p < 0.01). Higher CRP values were found in patients with 3 vessel coronary artery diseases 20.7 ± 8 mg/L, vs. 8.7 ± 4 mg/L with 2 and 1 vessel disease (p < 0.05). Patients with in-hospital complications had higher CRP, 33.7 ± 10 mg/L vs. 12.1 ± 5 mg/L in those without (p < 0.001). Eight patients died at one-year follow-up. The CRP levels on admission in patients who died during the first year of follow-up, 45.2 ± 7.7 mg/L were higher than those in the survivors without adverse events, 11.6 ± 5 mg/L (p < 0.001). Admission CRP level in patients re-admitted with unstable angina, re-infarction or those who had coronary bypass surgery was similar to that in those who were not. Conclusions: Very early blood CRP levels in patients with AMI predict functional capacity, systolic left ventricular function, extent of coronary artery disease, early and short term complications and 1-year mortality but not recurrent myocardial ischemic events.