Copyright © 2003 by the European Society of Cardiology.
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Predictive value of basal C-reactive protein levels for myocardial salvage in patients with acute myocardial infarction is dependent on the type of reperfusion treatment
a Deutsches Herzzentrum, Technische Universität München, Munich, Germany
b 1. Medizinische Klinik rechts der Isar, Technische Universität München, Munich, Germany
c Klinik und Poliklinik für Nuklearmedizin rechts der Isar, Technische Universität München, Munich, Germany
* Address for correspondence: Dr Adnan Kastrati, Deutsches Herzzentrum München, Lazarettstr. 36, 80636 Munich, Germany. Tel: +49-89-12184577; Fax: +49-89-12184593
E-mail address: kastrati{at}dhm.mhn.de
Received 25 November 2002; revised 5 February 2003; accepted 19 February 2003
Aims To evaluate whether C-reactive protein (CRP) levels on admission are predictive of myocardial salvage achieved with different reperfusion strategies in patients with acute myocardial infarction (AMI).
Methods and results Patients with AMI treated with stenting plus abciximab (n=125) and thrombolysis alone (n=54) or with abciximab (n=71) were prospectively studied. CRP levels were measured by a high sensitivity assay. The threshold of the upper quartile (12mg/l) was used to divide patients into two groups: 60 patients with high CRP (>12mg/l) and 190 patients with low CRP (
12 mg/l). Myocardial salvage was measured by technetium (Tc)-99msestamibi scintigraphy. Patients in the high CRP group had a significantly lower salvage index (0.35±0.42 vs 0.48±0.34, p=0.01) and higher 18-month mortality (11.7 vs 3.2%, p=0.03) compared to those in the low CRP group. While basal CRP was not related to myocardial salvage in patients treated with stenting plus abciximab (p=0.89) or thrombolysis plus abciximab (p=0.43), a high CRP on admission was associated with a significantly lower salvage index (0.09±0.48 vs 0.42±0.37 in the low CRP group, p=0.006) among patients treated with thrombolysis alone.
Conclusion CRP levels on admission may predict the efficacy of reperfusion in patients with AMI. The predictive ability is dependent on the form of reperfusion therapy.
Key Words: Inflammation • myocardial infarction • reperfusion • scintigraphy • stents • thrombolysis
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