Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus

Cardiovascular Diabetology

Monica De Metrio¹  Giancarlo Marenzi¹  Alice Bonomi¹  Valentina Milazzo¹  Nicola Cosentino¹  Mara Rubino¹  Jeness Campodonico¹  Daniela Riggio¹  Maurizio Rondinelli¹  Claudia Lucci¹  Katia Celentano¹  Fabrizio Veglia¹  Nicolò Capra¹  Maria Luisa Biondi¹  Stefano Genovese¹  Antonio L. Bartorelli²  Piergiuseppe Agostoni³ 

[1] Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy;Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy;Department of Biomedical and Clinical Sciences, “Luigi Sacco”, University of Milan, Milan, Italy;Centro Cardiologico Monzino IRCCS, Via Parea 4, 20138, Milan, Italy;Department of Clinical Sciences and Community Health - Cardiovascular Section, University of Milan, Milan, Italy;

关键词: Acute myocardial infarction;    Inflammation;    High-sensitivity C-reactive protein;    Diabetes mellitus;   

DOI  :  10.1186/s12933-020-01157-7

来源: Springer

【 摘 要 】

BackgroundHigh-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM.MethodsWe prospectively included 2064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint.ResultsTwenty-six percent (n = 548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P < 0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend < 0.0001), in DM (14%, 9%, 21%, 27%; P = 0.0001), and non-DM (5%, 8%, 10%, 19%; P < 0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value ≥ 2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value ≥ 2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients.ConclusionsThis study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.

【 授权许可】

CC BY