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European Heart Journal Advance Access originally published online on August 31, 2007
European Heart Journal 2008 29(10):1241-1249; doi:10.1093/eurheartj/ehm338
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

Predictive value of high sensitivity C-reactive protein in patients with ST-elevation myocardial infarction treated with percutaneous coronary intervention

Paolo Ortolani1,*, Antonio Marzocchi1, Cinzia Marrozzini1, Tullio Palmerini1, Francesco Saia1, Nevio Taglieri1, Federica Baldazzi1, Simona Silenzi1, Maria Letizia Bacchi-Reggiani1, Paolo Guastaroba2, Roberto Grilli2 and Angelo Branzi1

1 Institute of Cardiology, Azienda Ospedaliera S.Orsola-Malpighi Hospital, University of Bologna, Via Massarenti 9, Bologna 40138, Italy
2 Regional Health Agency of Emilia-Romagna, Bologna, Italy

Received 10 February 2007; revised 12 June 2007; accepted 16 July 2007; online publish-ahead-of-print 31 August 2007.

* Corresponding author. Tel: +39 0516364477, Fax: +39 051344859, Email: paortol{at}tin.it

Aims: To evaluate the predictive value of high sensitivity (hs) C-reactive protein levels on long-term survival in patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI.

Methods and results: We conducted a retrospective analysis of 758 STEMI patients (from January 2003 to December 2005), with STEMI onset <12 h and hs-C-reactive protein determination on admission.

Patients were classified into four groups [I (hs-C-reactive protein < 0.48 mg/dL), II (hs-C-reactive protein ≥ 0.48 to <1.2 mg/dL), III (hs-C-reactive protein ≥ 1.2 to <3.1 mg/dL), IV (hs-C-reactive protein ≥ 3.1 mg/dL)] according to quartiles of hs-C-reactive protein serum level. The IV quartile hs-C-reactive protein group had a higher incidence of in-hospital mortality and cumulative adverse events. At a mean follow-up of 724 ± 376 days (range 0–1393), the IV quartile hs-C-reactive protein group showed lower estimated survival, lower estimated myocardial infarction-free survival and lower estimated event-free survival. At multivariable analysis hs-C-reactive protein appeared to be an independent predictor of long-term mortality (HR: 1.04, 95% CI: 1.01–1.07, P = 0.003), long-term mortality and re-infarction (HR: 1.03, 95% CI: 1.01–1.06, P = 0.008) and adverse events (HR: 1.03, 95% CI: 1.01–1.05, P = 0.03).

Conclusion: Evaluation of hs-C-reactive protein on admission in STEMI patients undergoing primary PCI allows reliable risk stratification of these patients.

Key Words: Myocardial infarction • Angioplasty • Transluminal • Percutaneous coronary • High-sensitivity C-reactive protein


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