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Prognosis after acute myocardial infarction as predicted by CRP and clinical variables
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective. Raised concentrations of C-reactive protein (CRP) have been reported to be strongly related to an adverse long term prognosis in patients with acute myocardial infarction (AMI). However, adjustments for possible confounders have often been incomplete. Thus the clinical usefulness of CRP to predict long term survival in absolute figures has not been clarified. The aims of this study were to examine the predictive value of baseline concentrations of CRP for mortality after adjustment for the most important clinical variables and to compare the clinical usefulness of CRP with easily available clinical variables in the prediction of long term survival.

Design. Five hundred and thirty-one patients with AMI were included. A blood sample for CRP was obtained on admission. All patients were followed for a minimum of two years and death of any cause was recorded as the study end point.

Results. In logistic regression analysis the interaction term age by Killip class > 1 and the variables glomerular filtration rate, intervention and atrial fibrillation were retained. The resulting model correctly predicted death or not in 82% of the patients. CRP did not contribute to the final model.

Conclusions. An elevated C-reactive protein concentration is reported to be associated with death in patients with AMI, but the association is absent after adjustment for an important interaction among the variables in the model. CRP has no value beyond clinical variables in predicting death after AMI.

Keyword [en]
C-reactive protein, Myocardial infarction, Prognosis, Death
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
URN: urn:nbn:se:umu:diva-32518OAI: oai:DiVA.org:umu-32518DiVA: diva2:303931
Available from: 2010-03-16 Created: 2010-03-16 Last updated: 2016-05-23Bibliographically approved
In thesis
1. Inflammation, platelet aggregation and prognosis in acute myocardial infarction
Open this publication in new window or tab >>Inflammation, platelet aggregation and prognosis in acute myocardial infarction
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The incidence of stroke and re-infarction is noticeably high in the first few days following acute myocardial infarction. This finding has raised questions whether the systemic inflammatory reaction secondary to myocardial necrosis is involved. The inflammation might affect the activation of platelets leading to insufficient effect of the antiplatelet treatment given. Furthermore, the importance of platelet reactivity and inflammation in terms of long-term prognosis is not fully understood. The prognostic importance of C-reactive protein (CRP) in relation to clinical variables also needs to be clarified.

The present studies are aimed at describing the dynamics of platelet function during the first days of an acute myocardial infarction, in relation to diabetes and inflammation. We also investigated whether increased platelet reactivity or the increased concentration of CRP in blood were related to a worse outcome. Finally, we examined if CRP levels contributed to a predictive model using clinical variables known to affect outcome in patients with AMI.

 We used two novel platelet function tests to measure platelet reactivity; the PA-200 (a laser light aggregometer) and the PFA-100 (measures primary haemostasis in whole blood).

Platelet aggregation increased during the initial course of an acute myocardial infarction. The increase in platelet aggregation was most pronounced in diabetics and in patients showing higher systemic inflammatory reaction, assessed by measuring the concentration of CRP in blood. The pronounced platelet aggregation occurred despite ongoing antiplatelet and antithrombotic treatment.

There was a significant association between the levels of CRP and the degree of platelet reactivity. However, while the CRP levels were associated with a worse outcome (AMI, stroke and death), the results of the platelet function tests were not. The importance of CRP in predicting prognosis depended on which adjustments were made for confounding factors.

CRP and prognostic variables in a statistical model predicting death, however, showed that CRP was excluded. Thus CRP did not predict outcome beyond clinical prognostic variables.

The results of these studies reinforce the importance of clinical variables such as heart failure, age, atrial fibrillation, smoking status, diabetes and impaired kidney function - all of which were associated with worse prognosis in multivariable analysis.

Publisher
49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1343
Keyword
Myocardial infarction, C-reactive protein, platelet aggregation, prognosis
National Category
Cardiac and Cardiovascular Systems
Research subject
Medicine
Identifiers
urn:nbn:se:umu:diva-32519 (URN)978-91-7264-845-6 (ISBN)
Public defence
2010-04-29, Sal B, 9 trappor, By 1D, Tandläkarhögskolan, Umeå universitets sjukhus, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2010-03-19 Created: 2010-03-16 Last updated: 2010-03-19Bibliographically approved

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