(Circulation. 1997;96:778-784.)
© 1997 American Heart Association, Inc.
Articles |
C-Reactive Protein as a Predictor of Infarct Expansion and Cardiac Rupture After a First Q-Wave Acute Myocardial Infarction
From the Cardiopulmonary Division, Department of Medicine, Keio University School of Medicine, Tokyo, Japan.
Correspondence to Toshihisa Anzai, MD, Cardiology Section (9111A), Department of Veterans Affairs Medical Center, University of California, San Diego, 3350 La Jolla Village Dr, San Diego, CA 92161. E-mail tanzai{at}vapop.ucsd.edu
Background Pump failure after acute myocardial infarction (AMI) can be predicted by several indices that estimate infarct size. However, there are few indices that predict infarct expansion and cardiac rupture. We focused on the prognostic significance of serum C-reactive protein (CRP) after AMI.
Methods and Results Serum CRP levels were measured every 24
hours in 220 patients with a first Q-wave AMI. In-hospital
complications, predischarge left ventriculographic findings, and
long-term prognosis were assessed in relation to peak CRP levels. Peak
levels of both CRP and creatine kinase (CK) were higher in patients
with pump failure than in those without pump failure. In patients with
cardiac rupture, peak CRP levels were higher than in those without
rupture (P=.001); peak CK levels were not predictive. Higher
CRP levels were found in patients with left ventricular
aneurysm (P=.001 versus those without), aggravated
heart failure (P=.03 versus those without), and cardiac
death (P<.0001 versus survivors) during the first year
after AMI. Multivariate analysis confirmed that
an elevation of the peak CRP level 
20 mg/dL was an independent
predictor of cardiac rupture (relative risk, 4.72; P=.004),
left ventricular aneurysmal formation (relative
risk, 2.11; P=.03), and 1-year cardiac death (relative risk,
3.44; P<.0001).
Conclusions Cardiac rupture, left ventricular aneurysmal formation, and 1-year cardiac death were associated with an elevation of serum CRP early after AMI, suggesting that elevation of CRP levels after AMI may predict infarct expansion.
Key Words: proteins • aneurysm • myocardial infarction
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