doi: 10.1161/01.CIR.0000012625.02748.62
(Circulation. 2002;105:1412.)
© 2002 American Heart Association, Inc.
Inflammation and Long-Term Mortality After Non–ST Elevation Acute Coronary Syndrome Treated With a Very Early Invasive Strategy in 1042 Consecutive Patients
From Herz-Zentrum Bad Krozingen, Germany (C.M., H.J.B., H.R., F.-J.N.); the University Hospital Basel, Switzerland (C.M., S.M., A.P.P.); and MetroHealth Medical Center, Cleveland, Ohio (J.M.H.).
Correspondence to Dr Heinz Joachim Buettner, Herz-Zentrum, D-79189-Bad Krozingen, Germany. E-mail achim.buettner{at}herzzentrum.de
Background— This study sought to evaluate the predictive value of C-reactive protein (CRP) on long-term mortality in non–ST-elevation acute coronary syndromes (NSTACS) that were treated with a very early aggressive revascularization strategy.
Methods and Results— We conducted a prospective cohort study in 1042 consecutive patients with NSTACS who were undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularization strategy within 24 hours. Levels of CRP were determined on admission. The patients were followed for a mean of 20 months. In-hospital mortality was significantly higher in patients with a CRP>10 mg/L (3.7% versus 1.2% with CRP<3 mg/L and versus 0.8% with CRP of 3 to 10 mg/L; relative risk for CRP>10 mg/L compared with CRP
10 mg/L was 4.2, 95% confidence interval [CI] was 1.6 to 11.0; P=0.004). The increase in mortality in patients with CRP>10 mg/L persisted during follow-up. Long-term mortality was 3.4% with CRP<3 mg/L, 4.4% with CRP between 3 and 10 mg/L, and 12.7% with CRP>10 mg/L (relative risk for CRP>10 mg/L compared with CRP10 mg/L, 0.8; 95% CI, 2.3 to 6.2; P<0.001). In addition, Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 4 years in patients with a CRP>10 mg/L (78% versus 88% for a CRP of 3 to 10 mg/L and versus 92% for CRP<3 mg/L; P<0.001 by log-rank). In a multivariate analysis, CRP was an independent predictor of long-term mortality. Patients with a CRP>10 mg/L had >4 times the risk of death (odds ratio, 4.1; 95% CI, 2.3 to 7.2).
Conclusion— CRP is a strong independent predictor of short and long-term mortality after NSTACS that are treated with very early revascularization.
Key Words: angina • inflammation • revascularization
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