To Explore The Relationship Between Hypersensitive C-reactive Protein And The Prognosis Of Patients With Acute Myocardial Infarction After Percutaneous Coronary Intervention

ObjectiveTo explore the relationship between hypersensitive C-reactive protein (hs-CRP) and the prognosis of patients with acute myocardial infarction after percutaneous coronary intervention.MethodsThe study comprised 100 consecutive patients with first attack of acute myocardial infarction.They underwent primary percutaneous coronary intervention within 12 hours after the onset of chest pain.According to their serum hs-CRP level, these patients were divided into three groups:A Group(hs-CRP<3mg/L,n=18),B Group (3mg/L≤hs-CRP<10mg/L,n=32) and C Group (hs-CRP>10mg/L,n=50).The incidence of major adverse cardiac events within 180 postoperative days was followed.ResultsThere were no significant differences in age, sex, smoke, hyperlipidemia, diabetes mellitus, Cardiac troponin I and Low-density lipoprotein cholesterol among the three groups (P>0.05).There were significant differences in the serum hs-CRP levels,left ventricular ejection fraction, hypertension, left anterior descending coronary atery and anterior wall (P<0.05). Follow-up for 180 days showed that there were no significant differences in the incidence of major adverse cardiac events during hospitalization and within 30 days and 180 days among the three groups. But there were significant differences in the incidence of heart failure within 30 days or 180 days and revascularization rate within 180 days(P<0.05).using Binary logistic regression analysis, by step-back (LR) method, indicated that high concentration of hs-CRP remained an independent predicator of major adverse cardiac events during hospitalization and within 30 days (OR=2.42,95%CI=1.020～5.746,P=0.045); (OR=2.187, 95%CI=1.028～4.653, P=0.042). It is a more useful predictor for the incidence of heart failure within 30 days (OR=2.565,95%CI=1.032～6.375,P=0.043).ConclusionHigh level hs-CRP measured after the primary percutaneous coronary intervention is the independent predictive factors of major adverse cardiac events for the patients with first attack of acute myocardial infarction during hospitalization and within 30 days. It has a stronger predictive value, especially for the incidence of heart failure within 30 days. The patients of high level hs-CRP group is more than the normal hs-CRP group in the occurrence of major adverse cardiac events during hospitalization and within 30 days and the occurrence of heart failure within 30 days.IntroductionThe Study found that acute-phase protein—hypersensitive C-reactive protein (hs-CRP) is an independent risk factor for coronary heart disease, current research focuses more on risk assessment of hs-CRP in healthy people and subclinical coronary atherosclerosis patients, The research is seldom about whether hypersensitive C-reactive protein is valuable for predicting the prognosis of patients with acute myocardial infarction (AMI) after percutaneous coronary intervention. This study is aimed to explore the relationship between the hs-CRP levels in patients with AMI after percutaneous coronary intervention and major adverse cardiac events (MACE) during hospitalization and medium-term, and evaluate the value of hypersensitive C-reactive protein for predicting the prognosis of patients with acute myocardial infarction after primary percutaneous coronary intervention (PCI).Material and methods1. Subject(1) Research objects and groupingBetween March 2009 and September 2009, the patient diagnosed as incipient AMI and received successful treatment of primary PCI within 12 hours in the department of cardiology of our hospital is 100, man (76 cases,76%); women (24 cases,24%). The patients were divided into three groups:A group (hs-CRP<3mg/L, n=18); B group (3mg/L≤hs-CRP<10mg/L, n=32); C group (hs-CRP≥10mg/L, n=50), according to the serum hs-CRP levels of 24 hours after the operation. Record the patient's general clinical conditions (including age, sex, smoking history, history of hypertension, history of diabetes, history of hyperlipemia and anterior wall myocardial infarction, etc.) and coronary angiography and PCI information, including time of onset to operation, operative duration and coronary lesion severity (chronic total occlusion lesions, three lesions), infarct-related artery (left anterior descending artery, circumflex, right coronary artery, left main lesions), etc.(2) Diagnosis and exclusion criteriaAMI is diagnosed with AMI diagnostic criteria in 2007 ACC/AHA, must be consistent with at least two items:Typical symptoms of ischemic chest pain; ECG characteristic dynamic evolution; biochemical markers of myocardial necrosis consistent with characteristic changes of myocardial infarction. Exclusion criteria:①old myocardial infarction.②after the percutaneous coronary angioplasty (PTCA) or the coronary artery stent implantation(CASI).③severe heart failure, LVEF<30%.④severe liver and kidney dysfunction or accompanying malignant tumors.⑤other diseases or factors influence hs-CRP (such as myocarditis, cardiomyopathy, infective endocarditis, rheumatic heart disease, connective tissue disease and other acute or chronic infection).⑥without trauma, surgery and serious infections history within three months.(3) Coronary angiography and PCI treatmentCoronary angiography and PCI is according to the routine approach. The successful standard of PCI is the vascular lumen diameter of target coronary artery significantly increased after PCI, the smallest diameter of the vascular is less than 20%, and no major clinical complications during hospitalization [such as death, myocardial infarction (MI), emergency target lesion revascularization (TLR)].(4) MedicationAccording to preoperative conventional methods of anti-platelet drugs oraly, given loading doze of aspirin 300mg, clopidogrel 300mg, followed by maintenance doze of aspirin 300mg/d, adjusted to 100mg/d a month later for lifetime, clopidogrel 75～ 150mg/d, take for at least one year. Give the patients with acute myocardial infarction (AMI) low molecular weight heparin as conventional treatment for 5～7days during perioperation. Such as expanding coronary artery, cardiotonic, antihypertensive drugs, statins in lowering cholesterol, hypoglycemic therapy and so on accord to the conventional methods.2. Methods(1) Hs-CRP in serum and other biochemical markers of blood testSubjects were collected 3ml of the blood samples from venous at the 24th hours after operation, separated the serum, then send it to the clinical laboratory for testing hs-CRP by immunoturbidimetric methods, normal range 0-3mg/L. By chemiluminescence to test cardiac troponin I (TNI), Kit purchased from Abbott Laboratories Inc of USA. The normal reference value is less than 0.04ng/ml. At the same time the blood cholesterol and glucose are tested.(2) Determination of left ventricular ejection fractionThe next day after operation, evaluate left ventricular systolic function by using PHILIPS SONOS-5500 echocardiography instrument to measure left ventricular ejection fraction (LVEF),.3. MACE occurrence(1) MACE definetionsIncluding angina pectoris, the same part of re-infarction, infarct-related artery re-revascularization, heart failure and cardiac death.(2) The occurrence of MACE during hospitalizationDetailed record the occurrence of MACE during hospitalization(3) Mid-term Follow-upFollow-up 30 days and 180 days, record the occurrence of MACE through clinics or telephone follow-up methods, the observation period is 180 days, including the general clinical condition, medication, angina pectoris, heart function classification and other observed MACE4. Statistical methodsUse SPSS 16 package for statistical analysis. The measurement datas of normal distribution were indicated by mean±standard, compared with Bonferroni test of one -way ANOVA for multiple overall mean. The measurement datas of non-norm distribution were indicated by the median and 95% CI, compared with several independent samples rank sum test. Enumeration data were indicated by rate or composition, compared with Row×Column data pearson chi-square test. Using Binary Logistic regression multivariate analysis of step-back (LR) method, with MACE as the independent variable,so that general information (age, sex, anterior wall myocardial infarction and left ventricular ejection fraction) and coronary heart disease risk factors (smoking, history of hypertension, hyperlipidemia history, history of diabetes) and single factor analysis indicated that statistically significant factors (hs-CRP levels, left anterior descending coronary artery disease, etc.) turn into the regression analysis. P<0.05 indicated that the difference was statistically significant.Results1. Compared with general clinical data, infarct-related artery and coronary lesion severity of three groupsThere was no significant differences in age,sex, smoke, hyperlipidemia, diabetes mellitus, time of onset to operation, operative duration, Cardiac troponin I,Low-density lipoprotein cholesterol and coronary lesion severity (chronic total occlusion lesions, three lesions), infarct-related artery (circumflex, right coronary artery, left main lesions)among the three groups (P>0.05).There was significant differences in the serum hs-CRP levels, Left ventricular ejection fraction, hypertension, left anterior descending coronary atery and anterior wall myocardial infarction (P<0.05). Three groups of hypertension [A group (8 cases,44.4%) vs B group (23 cases,71.9%) vs C group (19 cases,38.0%); P=0.010], left ventricular ejection fraction [A group (58%,95% CI 53.46%-61.12%) vs B group (55%,95% CI 52.6%-57.47%) vs C group (50%,95% CI 46.64%-52.62%); P=0.007], left anterior descending coronary artery disease [A group (10 cases,55.6%) vs B group (10 cases,31.2%) vs C group (30 cases,60.0%); P= 0.035], anterior wall myocardial infarction [A group (8 cases,44.4%) vs B group (8 cases,25.0%) vs C group (27 cases,54.0%); P=0.035]; the serum hs-CRP levels[A group (1.42,95% CI 1.06-1.91) vs B group (6.14,95% CI 5.59-6.98) vs C group (27.8,95% CI 25.78-47.17); P=0.000]. There was a significant difference (P<0.05).2.The occurrence of MACE (1) Comparison of the incidence of MACEThe patients of three groups were followed up for 180 days, which one case of B group was lost, and another one was died of brain stem hemorrhage. Withdraw rate is 2.0%.Follow-up for 180 days showed that there were no significant differences in the incidence of MACE within hospitalization,30 days and 180 days among the three groups. But the incidence of heart failure within 30 days [A group (0 cases,0.0%) vs B group (1 case,3.1%) vs C group (0 cases,0.0%); P=0.037], revascularization rates within 180 days [A group (0 cases,0.0%) vs B group (5 cases,16.1%) vs C group (1 case,2.0%); P=0.017] and the incidence of heart failure [A group (3 cases,16.7%) vs B group (5 cases,16.1%) vs C group (20 cases,40.0%); P=0.033] have more significant difference (P<0.05).(2) Comparison of the occurrence risk of MACEUsing Binary Logistic regression multivariate analysis, taking step-back (LR) method, the final screening results showed that high level hs-CRP measured at the 24th hours after the primary PCI is the independence predictive factors of the incidence of MACE for the patients with first AMI during hospitalization and within 30 days, the OR values were [2.42,95% CI (1.020-5.746), P=0.045]; [2.187,95% CI (1.028-4.653), P=0.042]. It has a stronger predictive value, especially for the incidence of heart failure within 30 days, the OR value was [2.565,95% CI (1.032-6.375), P=0.043]. Indicated that the patients of high level hs-CRP group were the normal hs-CRP group 2.4 times and 2.2 times in the occurred risk of MACE during hospitalization and within 30 days, the occurred risk of heart failure within 30 days was 2.6 times. Table 7.ConclusionHigh level hs-CRP measured at the 24th hours after the primary PCI is the independent predictive factors of the incidence of MACE for the patients with first AMI during hospitalization and within 30 days. It has a stronger predictive value, especially for the incidence of heart failure within 30 days. The patients of high level hs-CRP group is more than the normal hs-CRP group in the occurrence of MACE during hospitalization and within 30 days and the occurrence of heart failure within 30 days.