High-Sensitivity C-Reactive Protein Is Within Normal Levels at the Very Onset of First ST-Segment Elevation Acute Myocardial Infarction in 41% of Cases A Multiethnic Case-Control Study

被引:63
作者
Cristell, Nicole [1 ]
Cianflone, Domenico [1 ]
Durante, Alessandro [1 ]
Ammirati, Enrico [1 ]
Vanuzzo, Diego [3 ]
Banfi, Michela [1 ]
Calori, Giliola [1 ]
Latib, Azeem [1 ]
Crea, Filippo [4 ]
Marenzi, Giancarlo [2 ]
De Metrio, Monica [2 ]
Moretti, Luciano [5 ]
Li, Hui [7 ]
Uren, Neal G. [8 ]
Hu, Dayi [7 ]
Maseri, Attilio [6 ]
机构
[1] Univ Vita Salute San Raffaele, Ist Sci San Raffaele, I-20132 Milan, Italy
[2] Univ Milan, Ctr Cardiol Monzino, Dept Cardiovasc Sci, Milan, Italy
[3] Cardiovasc Prevent Ctr Hlth Unit 4 Medio Friuli, Udine, Italy
[4] Univ Cattolica Sacro Cuore, Rome, Italy
[5] Osped Gen Provinciale Mazzoni, Ascoli Piceno, Italy
[6] Fdn Per Tuo Cuore Heart Care Fdn ONLUS, Florence, Italy
[7] Peoples Hosp, Beijing, Peoples R China
[8] Royal Infirm, Edinburgh Heart Ctr, Edinburgh, Midlothian, Scotland
关键词
high-sensitivity C-reactive protein; myocardial infarction; ST-segment elevation myocardial infarction; CORONARY-HEART-DISEASE; 52; COUNTRIES; RISK; INFLAMMATION; PREDICTION; MARKERS; INTERLEUKIN-6; INTERHEART; MORTALITY; ANGINA;
D O I
10.1016/j.jacc.2011.08.055
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives This study sought to assess the prevalence of normal levels of high sensitivity C-reactive protein (hsCRP) at the very onset of ST-segment elevation myocardial infarction (STEMI). Background Levels of hsCRP >2 mg/l identify individuals who benefit from lipid lowering and possibly anti-inflammatory agents, but how many patients develop infarction in spite of hsCRP levels <2 mg/l and thus would be ineligible for these treatments? Methods We studied 887 patients with unequivocally documented STEMI as the first manifestation of coronary disease and 887 matched control subjects from urban areas of Italy, Scotland, and China. Blood samples were obtained before reperfusion strategies <6 h from symptoms onset in order to limit acute event-related increases. Results hsCRP values were similar in samples obtained <2 h, 2 to 4 h, and 4 to 6 h from symptoms onset in all ethnic groups, consistent with the delayed hsCRP elevation after myocardial necrosis and thus indicative of pre-infarction levels. Median hsCRP values were significantly higher in patients than in control subjects: 2.49 (interquartile range [IQR]: 1.18 to 5.55) mg/l versus 1.32 (IQR: 0.58 to 3.10) mg/l (p < 0.0001), which is consistent with previous findings. However, 41% of patients had hsCRP levels <2 mg/l and conversely, 37% of control subjects had values >= 2 mg/l. Conclusions The measurement of hsCRP, with a 2 mg/l cutoff, would not have predicted 41% of unequivocally documented STEMIs in 3 ethnic groups without evidence of previous coronary disease, thus indicating both its limitations as an individual prognostic marker and as an indicator of a generalized inflammatory pathogenetic component of STEMI. New specific prognostic and therapeutic approaches should be found for such a large fraction of patients at risk. (J Am Coll Cardiol 2011;58:2654-61) (C) 2011 by the American College of Cardiology Foundation
引用
收藏
页码:2654 / 2661
页数:8
相关论文
共 18 条
[1]   C-reactive protein and coronary heart disease: a critical review [J].
Casas, J. P. ;
Shah, T. ;
Hingorani, A. D. ;
Danesh, J. ;
Pepys, M. B. .
JOURNAL OF INTERNAL MEDICINE, 2008, 264 (04) :295-314
[2]   Use and misuse of the receiver operating characteristic curve in risk prediction [J].
Cook, Nancy R. .
CIRCULATION, 2007, 115 (07) :928-935
[3]   C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease [J].
Danesh, J ;
Wheeler, JG ;
Hirschfield, GM ;
Eda, S ;
Eiriksdottir, G ;
Rumley, A ;
Lowe, GDO ;
Pepys, MB ;
Gudnason, V .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (14) :1387-1397
[4]   Long-term interleukin-6 levels and subsequent risk of coronary heart disease: Two new prospective studies and a systematic review [J].
Danesh, John ;
Kaptoge, Stephen ;
Mann, Andrea G. ;
Sarwar, Nadeem ;
Wood, Angela ;
Angleman, Sara B. ;
Wensley, Frances ;
Higgins, Julian P. T. ;
Lennon, Lucy ;
Eiriksdottir, Gudny ;
Rumley, Ann ;
Whincup, Peter H. ;
Lowe, Gordon D. O. ;
Gudnason, Vilmundur .
PLOS MEDICINE, 2008, 5 (04) :600-610
[5]  
DEBEER FC, 1982, BRIT HEART J, V47, P239
[6]   States, rates and traits: prognosis research and chronic stable angina [J].
Hemingway, Harry .
HEART, 2009, 95 (06) :439-440
[7]   Relationship between interleukin 6 and mortality in patients with unstable coronary artery disease - Effects of an early invasive or noninvasive strategy [J].
Lindmark, E ;
Diderholm, E ;
Wallentin, L ;
Siegbahn, A .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2001, 286 (17) :2107-2113
[8]   THE PROGNOSTIC VALUE OF C-REACTIVE PROTEIN AND SERUM AMYLOID-A PROTEIN IN SEVERE UNSTABLE ANGINA [J].
LIUZZO, G ;
BIASUCCI, LM ;
GALLIMORE, JR ;
GRILLO, RL ;
REBUZZI, AG ;
PEPYS, MB ;
MASERI, A .
NEW ENGLAND JOURNAL OF MEDICINE, 1994, 331 (07) :417-424
[9]  
McCloskey DN, 1996, J ECON LIT, V34, P97
[10]   Lipids, lipoproteins, and apolipoproteins as risk markers of myocardial infarction in 52 countries (the INTERHEART study): a case-control study [J].
McQueen, Matthew J. ;
Hawken, Steven ;
Wang, Xingyu ;
Ounpuu, Stephanie ;
Sniderman, Allan ;
Probstfield, Jeffrey ;
Steyn, Krisela ;
Sanderson, John E. ;
Hasani, Mohammad ;
Volkova, Emilia ;
Kazmi, Khawar ;
Yusuf, Salim .
LANCET, 2008, 372 (9634) :224-233