Key result
High-sensitivity C-reactive protein was not predictive of recurrent MACE (P=0.11), but independently predicted 30-day mortality (OR 1.27; 95% CI 1.07-1.51; P=0.005).
Why the study?
Does high-sensitivity C-reactive protein predict 30-day MACE or mortality in patients with STEMI treated with primary PCI?
Cohort (n=300)
No
Does high-sensitivity C-reactive protein predict 30-day MACE or mortality in patients with STEMI treated with primary PCI?
p-value: p=0.11
In patients with STEMI undergoing primary PCI, elevated hs-CRP is an independent predictor of 30-day mortality, although it does not significantly predict the broader composite of 30-day MACE.
hs-CRP was associated with 30-day mortality but not recurrent MACE after STEMI PCI; hypothesis-generating and should not yet change practice.
BACKGROUND: The association between high-sensitivity C-reactive protein and recurrent major adverse cardiovascular events (MACE) in patients with ST-elevation myocardial infarction who undergo primary percutaneous coronary intervention remains controversial. OBJECTIVE: To investigate the potential association between high-sensitivity C-reactive protein and an increased risk of MACE such as death, heart failure, reinfarction, and new revascularization in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. METHODS: This prospective cohort study included 300 individuals aged >18 years who were diagnosed with ST-elevation myocardial infarction and underwent primary percutaneous coronary intervention at a tertiary health center. An instrument evaluating clinical variables and the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events (GRACE) risk scores was used. High-sensitivity C-reactive protein was determined by nephelometry. The patients were followed-up during hospitalization and up to 30 days after infarction for the occurrence of MACE. Student's t, Mann-Whitney, chi-square, and logistic regression tests were used for statistical analyses. P values of ≤0.05 were considered statistically significant. RESULTS: The mean age was 59.76 years, and 69.3% of patients were male. No statistically significant association was observed between high-sensitivity C-reactive protein and recurrent MACE (p = 0.11). However, high-sensitivity C-reactive protein was independently associated with 30-day mortality when adjusted for TIMI [odds ratio (OR), 1.27; 95% confidence interval (CI), 1.07-1.51; p = 0.005] and GRACE (OR, 1.26; 95% CI, 1.06-1.49; p = 0.007) risk scores. CONCLUSION: Although high-sensitivity C-reactive protein was not predictive of combined major cardiovascular events within 30 days after ST-elevation myocardial infarction in patients who underwent primary angioplasty and stent implantation, it was an independent predictor of 30-day mortality.
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Ribeiro et al. (2014) conducted a cohort in ST-elevation myocardial infarction (n=300). High-sensitivity C-reactive protein was evaluated on Recurrent major adverse cardiovascular events (MACE) (p=0.11). High-sensitivity C-reactive protein was not predictive of recurrent MACE (P=0.11), but independently predicted 30-day mortality (OR 1.27; 95% CI 1.07-1.51; P=0.005).
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