TY - JOUR
T1 - 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
T2 - A multiethnic case-control study
AU - Cristell, Nicole
AU - Cianflone, Domenico
AU - Durante, Alessandro
AU - Ammirati, Enrico
AU - Vanuzzo, Diego
AU - Banfi, Michela
AU - Calori, Giliola
AU - Latib, Azeem
AU - Crea, Filippo
AU - Marenzi, Giancarlo
AU - De Metrio, Monica
AU - Moretti, Luciano
AU - Li, Hui
AU - Uren, Neal G.
AU - Hu, Dayi
AU - Maseri, Attilio
N1 - Funding Information:
This study has been supported by unrestricted grants from the Fondazione per il Cuore ONLUS Roma (Italy), a nonprofit organization , and the Ministero dell'Istruzione dell'Università e della Ricerca (Italy) grant number: FIRB RBAU01FSA4 and Regione Friuli (Italy). The funding sources had no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication. The authors have reported that they no relationships relevant to the contents of this paper to disclose. Drs. Cristell and Cianflone contributed equally to this paper.
PY - 2011/12/13
Y1 - 2011/12/13
N2 - 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.
AB - 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.
KW - ST-segment elevation myocardial infarction
KW - high-sensitivity C-reactive protein
KW - myocardial infarction
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U2 - 10.1016/j.jacc.2011.08.055
DO - 10.1016/j.jacc.2011.08.055
M3 - Article
C2 - 22152952
AN - SCOPUS:82955207677
SN - 0735-1097
VL - 58
SP - 2654
EP - 2661
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -