Prognostic impact of admission high-sensitivity C-reactive protein in acute myocardial infarction patients with and without diabetes mellitus.

Abstract

BACKGROUND:

High-sensitivity C-reactive protein (hs-CRP) elevation frequently occurs in acute myocardial infarction (AMI) and is associated with adverse outcomes. Since diabetes mellitus (DM) is characterized by an underlying chronic inflammation, hs-CRP may have a different prognostic power in AMI patients with and without DM.

METHODS:

We prospectively included 2064 AMI patients; hs-CRP was measured at hospital admission. Patients were grouped according to hs-CRP quartiles and DM status. The primary endpoint was a composite of in-hospital mortality, cardiogenic shock, and acute pulmonary edema. Two-year all-cause mortality was the secondary endpoint.

RESULTS:

Twenty-six percent (n = 548) of patients had DM and they had higher hs-CRP levels than non-DM patients (5.32 vs. 3.24 mg/L; P < 0.0001). The primary endpoint incidence in the overall population (7%, 9%, 13%, 22%; P for trend < 0.0001), in DM (14%, 9%, 21%, 27%; P = 0.0001), and non-DM (5%, 8%, 10%, 19%; P < 0.0001) patients increased in parallel with hs-CRP quartiles. The adjusted risk of the primary endpoint increased in parallel with hs-CRP quartiles in DM and non-DM patients but this relationship was less evident in DM patients. In the overall population, the adjusted OR of the primary endpoint associated with an hs-CRP value ≥ 2 mg/L was 2.10 (95% CI 1.46-3.00). For the same risk, hs-CRP was 7 and 2 mg/L in patients with and without DM. A similar behavior was observed for the secondary endpoint when the HR associated with an hs-CRP value ≥ 2 mg/L found in the overall population was 2.25 (95% CI 1.57-3.22). For the same risk, hs-CRP was 8 and 1.5 mg/L in DM and non-DM patients.

CONCLUSIONS:

This study shows that hs-CRP predicts in-hospital outcome and two-year mortality in AMI patients with and without DM. However, in DM patients, the same risk of developing events as in non-DM patients is associated to higher hs-CRP levels.

• Authors: Claudia Lucci, Nicola Cosentino, Stefano Genovese, Jeness Campodonico, Valentina Milazzo, Monica De Metrio, Maurizio Rondinelli, Daniela Riggio, Maria Luisa Biondi, Mara Rubino, Katia Celentano, Alice Bonomi, Nicolò Capra, Fabrizio Veglia, Piergiuseppe Agostoni, Antonio L Bartorelli, Giancarlo Marenzi
• Journal: Cardiovascular diabetology (Cardiovasc Diabetol) Vol. 19 Issue 1 Pg. 183 (10 20 2020) ISSN: 1475-2840 [Electronic] England
• PMID: 33081810 (Publication Type: Comparative Study, Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Biomarkers
• Inflammation Mediators
• C-Reactive Protein

Topics

• Aged
• Aged, 80 and over
• Biomarkers (blood)
• C-Reactive Protein (analysis)
• Diabetes Mellitus (blood, diagnosis, mortality)
• Female
• Hospital Mortality
• Humans
• Incidence
• Inflammation Mediators (blood)
• Male
• Middle Aged
• Non-ST Elevated Myocardial Infarction (blood, diagnosis, mortality)
• Patient Admission
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Pulmonary Edema (blood, mortality)
• Risk Assessment
• Risk Factors
• ST Elevation Myocardial Infarction (blood, diagnosis, mortality)
• Shock, Cardiogenic (blood, mortality)
• Up-Regulation