Document Detail


Differential impact of admission C-reactive protein levels on 28-day mortality risk in patients with ST-elevation versus non-ST-elevation myocardial infarction (from the Monitoring Trends and Determinants on Cardiovascular Diseases [MONICA]/Cooperative Health Research in the Region of Augsburg [KORA] Augsburg Myocardial Infarction Registry).
MedLine Citation:
PMID:  18940277     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The present study investigated the association between C-reactive protein (CRP) on admission independently and in combination with troponin and short-term prognosis in an unselected sample of patients with acute myocardial infarction (AMI) from the community. The study population consisted of 1,646 patients aged 25 to 74 years who were consecutively hospitalized with AMI within 12 hours after symptom onset. They were divided into the 2 groups of CRP positive (n = 919) or CRP negative (n = 727) with respect to admission CRP (cutoff < or =0.3 mg/dl). CRP-positive patients had significantly more in-hospital complications and a higher 28-day case-fatality rate (9.6% vs 3.4%; p <0.0001). Troponin at admission (n = 1,419) also correlated with 28-day case-fatality rate (troponin-negative 3.4% vs troponin-positive patients 8.0%; p <0.002). Multivariable analysis showed that both troponin positivity and CRP positivity were associated with a 2-fold (adjusted odds ratio 1.99, 95% confidence interval 1.15 to 3.44; adjusted odds ratio 2.05, 95% confidence interval 1.09 to 3.84, respectively) increased risk of dying within 28 days after the acute event for all patients with AMI. Stratifying by AMI type showed that in patients with ST-elevation myocardial infarction (STEMI), troponin positivity, but not CRP positivity, independently predicted 28-day case fatality. In patients with non-STEMI, CRP positivity, but not troponin positivity, predicted outcome. In conclusion, admission CRP was a powerful parameter for risk stratification of patients with AMI. Stratification by AMI type and troponin showed that CRP was a better short-term risk predictor for patients with non-STEMI, and troponin was, for patients with STEMI.
Authors:
Bernhard Kuch; Wolfgang von Scheidt; Birgitt Kling; Margit Heier; Allmut Hoermann; Christa Meisinger
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-08-15
Journal Detail:
Title:  The American journal of cardiology     Volume:  102     ISSN:  1879-1913     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-22     Completed Date:  2009-01-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1125-30     Citation Subset:  AIM; IM    
Affiliation:
I. Medizinische Klinik, Hospital of Augsburg, Teaching Hospital of the Ludwig Maximilians University München, Augsburg, Germany. bernhard.kuch@klinikum-augsburg.de
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
C-Reactive Protein / analysis*
Electrocardiography
Female
Humans
Male
Middle Aged
Myocardial Infarction / blood*,  mortality*
Predictive Value of Tests
Prognosis
Risk Assessment
Risk Factors
Troponin I / blood
Troponin T / blood
Chemical
Reg. No./Substance:
0/Troponin I; 0/Troponin T; 9007-41-4/C-Reactive Protein

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