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. 2021 May 24:8:659446.
doi: 10.3389/fcvm.2021.659446. eCollection 2021.

Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction

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Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction

Xiaoyuan Zhang et al. Front Cardiovasc Med. .

Abstract

Background: High sensitivity CRP (hs-CRP) has attracted intense interest in risk assessment. We aimed to explore its prognostic value in patients with acute myocardial infarction (AMI). Methods and Results: We enrolled 4,504 consecutive AMI patients in this prospective cohort study. The associations between hs-CRP levels with the incidence of in-hospital HF was evaluated by logistic regression analysis. The association between hs-CRP levels and the cumulative incidence of HF after hospitalization were evaluated by Fine-Gray proportional sub-distribution hazards models, accounting for death without HF as competing risk. Cox proportional hazards regression models were constructed to estimate the association between hs-CRP levels and the risk of all-cause mortality. Over a median follow-up of 1 year, 1,112 (24.7%) patients developed in-hospital HF, 571 (18.9%) patients developed HF post-discharge and 262 (8.2%) patients died. In the fully adjusted model, the risk of in-hospital heart failure (HF) [95% confidence intervals (CI)] among those patients with hs-CRP values in quartile 3 (Q3) and Q4 were 1.36 (1.05-1.77) and 1.41 (1.07-1.85) times as high as the risk among patients in Q1 (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.33 (1.00-1.76) and 1.80 times (1.37-2.36) as high as the risk of HF post-discharge compared with patients in Q1 respectively (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.74 (1.08-2.82) and 2.42 times (1.52-3.87) as high as the risk of death compared with patients in Q1 respectively (p trend < 0.001). Conclusions: Hs-CRP was found to be associated with the incidence of in-hospital HF, HF post-discharge and all-cause mortality in patients with AMI.

Keywords: acute myocardial infarction; heart failure; high sensitivity CRP; mortality; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study sample.
Figure 2
Figure 2
Restricted cubic spline fitting for the association between hs-CRP levels and in-hospital heart failure (A), heart failure post-discharge (B) and all-cause mortality (C). Odds ratios or Hazards ratios were evaluated by setting the hs-CRP value = 6 mg/L as reference based on a univariate logistic regression or Cox proportional regression model. The shaded area represents the 95% confidence interval.
Figure 3
Figure 3
Cumulative incidence of HF post-discharge treating death without HF as competing risk (A) and Kaplan–Meier plot of all-cause mortality (B) across hs-CRP quartiles. No., number.
Figure 4
Figure 4
Stratified analysis of in-hospital HF based on model II (A), HF after hospitalization (B) and Death based on model V (C). CI, confidence interval; STEMI, ST-segment elevation myocardial infarction; NSTEMI, non–ST-segment elevation myocardial infarction; BMI, Body mass index; eGFR, estimated glomerular filtration rate.

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