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Submitted: 16 May 2007 Modified: 25 June 2012
HERDIN Record #: PCHRDPC020346

The value of admission and pre-discharge serum c-reactive protein levels and its ratio in predicting ischemic events among low risk post myocardial infarction patients.

 Lam Sun Lao,
 Andriono Prasetyo

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Inflammation has been thought to play a role in the atherosclerotic process. C-reactive protein is the objective index of the overall inflammatory activity in the body
OBJECTIVES: This study evaluates the prognostic values of the admission, pre-discharge, and the ratio of pre-discharge over admission levels of C-reactive protein among patients with uncomplicated acute myocardial infarction and normal left ventricular function
METHODS AND RESULTS: Venous blood samples for C-reactive protein were obtained on admission and before discharge on 61 patients (44 males, 17 females) with a diagnosis of acute myocardial infarction who had an LV ejection fraction 45 percent and showed no signs of ischemia on pre-discharge exercise stress test. Follow-up for cardiac events was done for a period of six months. Baseline characteristics were essentially the same between groups with and without cardiac events except for the ejection fraction (p=0.001)
Serum C-reactive protein levels of patients on admission, pre-discharge and ratio of predischarge over admission were significantly higher for patients with cardiac events compared to patients without cardiac events. When the ratios of pre-discharge over admission serum CRP were divided into quartiles, patients belonging to the fourth quartile (ratio 0.7620) were found to have a 15-fold increased probability of developing a cardiac event p=0.001, RR 15.33, Cl 5.13-45.79) compared to patients in the first quartiles. Multivariate analysis revealed that the ratio of pre-discharge over admission CRP of greater than 0.6 is the only independent predictor of cardiac events and has a sensitivity of 100 percent and specificity of 97.7 percent for predicting cardiac events during the follow-up period
CONCLUSION: The ratio of pre-discharge over admission levels of serum C-reactive protein is more sensitive and specific than the admission or pre-discharge levels of C-reactive protein in predicting cardiac events during follow up period of low-risk post-myocardial infarction patients. Acute phase response to inflammatory events such as acute myocardial may vary according to undetermined individual determinants which in this case might be genetics. (Author)

Publication Type
Journal
Publication Sub Type
Announcements
Title
Philippine Heart Center Journal
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