Abstract 8789: Serial Measurements of C-Reactive Protein in Predicting Clinical Outcomes in Patients with Acute Aortic Intramural Hematoma
Background: Inflammation is involved in the pathogenesis and progression of acute aortic dissection, and a high circulating C-reactive protein (CRP) level may be a risk factor for adverse events in patients with aortic dissection. However, there is no data regarding time course in CRP levels during acute phase in patients with aortic intramural hematoma (IMH). The aim of this study was to evaluate the prognostic relevance of serial CRP measurements in patients with IMH.
Methods: A total of 180 IMH patients (age; 70±11 years, male/female; 105/75) who were admitted to our institution within 48 hours from the onset, were evaluated. CRP data were obtained at admission, 2 days, 1 week, 2 weeks from the onset and maximal values during hospitalization. Patients who underwent surgery within 2 weeks from the onset were excluded. Clinical outcomes were evaluated with a mean follow-up of 5.1±3.9 years.
Results: CRP levels were 3.0±4.6, 8.7±5.9, 9.0±5.5, and 5.7±4.5 mg/dL at admission, 2 days, 1 week and 2 weeks, respectively. Maximal value of CRP was 12.4±6.3 mg/dL. There were 23 deaths including 9 cases of aortic rupture, and 23 patients underwent surgical or percutaneous repair during follow-up and 19 patients showed progression to classic aortic dissection or aortic aneurysm without surgery. CRP levels at 2 weeks of patients with aorta-related events were significantly higher than that of patients without the events (8.8±5.2 vs 4.5±3.6; P<0.001). Receiver-operating characteristic curve analysis identified CRP level of 5.0 mg/dL at 2 weeks as a cut off for predicting aorta-related events, with sensitivity, specificity, and positive and negative predictive values of 71%, 66%, 35%, and 86%, respectively. The aorta-related event free survival was significantly higher in patients with lower CRP (≤5.0) at 2 weeks (P<0.001,Figure).
Conclusions: Sustained high levels of CRP at 2 weeks from the onset were associated with a progressive disease course in patients with IMH.
- © 2011 by American Heart Association, Inc.