C-reactive protein velocity predicts microvascular pathology after acute ST-elevation myocardial infarction

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:338

Article

Holzknecht, Magdalena¹  Tiller, Christina¹  Reindl, Martin¹  Lechner, Ivan¹  Troger, Felix²  Hosp, Michael¹  Mayr, Agnes²  Brenner, Christoph¹  Klug, Gert¹  Bauer, Axel¹  Metzler, Bernhard¹  Reinstadler, Sebastian Johannes¹ 

[1] Med Univ Innsbruck, Univ Clin Internal Med 3, Cardiol & Angiol, Anichstr 35, A-6020 Innsbruck, Austria

[2] Med Univ Innsbruck, Univ Clin Radiol, Anichstr 35, A-6020 Innsbruck, Austria

关键词: ST-elevation myocardial infarction;    C-reactive protein;    Microvascular obstruction;    Cardiac magnetic resonance imaging;   

DOI  :  10.1016/j.ijcard.2021.06.023

来源: Elsevier

【 摘 要 】

Background: The role of C-reactive protein velocity (CRPv) as an early and sensitive marker of an excessive inflammatory response in the setting of acute ST-elevation myocardial infarction (STEMI) is only poorly understood. The aim of this study was to investigate, in patients with STEMI treated with primary percutaneous coronary intervention (PCI), the association of CRPv with microvascular infarct pathology. Methods and results: This prospective cohort study included a total of 316 patients with STEMI undergoing PCI. CRPv was defined as the difference between CRP 24 +/- 8 h and CRP at hospital admission, divided by the time (in h) that have passed during the two examinations. The association of biomarker levels with cardiac magnetic resonance (CMR)-determined microvascular obstruction (MVO) was evaluated. CMR was performed at a median of 3 [interquartile range 2-4] days after PCI. After adjustment for cardiac troponin T (cTnT), anterior infarction and TIMI flow pre and post-PCI, CRPv (odds ratio 2.70, 95% confidence interval (CI) 1.54-4.73; p = 0.001) remained significantly associated with the occurrence of MVO. CRPv (area under the curve [AUC] 0.76, 95% CI 0.71-0.81; p < 0.001) was a better predictor for MVO compared to 24 h CRP (AUC difference: 0.03, p = 0.002). The addition of CRPv to peak cTnT resulted in a higher AUC for MVO prediction than peak cTnT alone (AUC 0.86, 95% CI 0.82-0.90; p < 0.001 vs. AUC 0.84, 95% CI 0.79-0.88; p < 0.001. AUC difference: 0.02, p = 0.042). Conclusions: In patients with STEMI treated with primary PCI, CRPv was associated with microvascular infarct pathology with a predictive value incremental to cTnT, suggesting CRPv as an early and sensitive biomarker for more severe infarct pathology and outcome. (c) 2021 The Author(s). Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

【 授权许可】

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