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Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death or acute myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction.
Am J Cardiol. 2002 Jan 15; 89(2):145-9.AJ

Abstract

High-sensitivity C-reactive protein (CRP), proposed as a new coronary risk marker, may reflect either an acute phase reaction or the level of chronic inflammation. Thus, CRP may be less predictive of long-term outcomes when measured after acute myocardial infarction (AMI) than after unstable angina pectoris (UAP) or stable angina pectoris (SAP). A total of 1,360 patients with severe coronary artery disease (>/=1 stenosis >/=70%) had CRP levels obtained at angiography. Presenting diagnoses were SAP (n = 599), UAP (n = 442), or AMI (n = 319). During follow-up (mean 2.8 years), death or nonfatal AMI (D/AMI) occurred in 19.5%, 16.1%, and 17.2% (p = NS) with SAP, UAP, and AMI, respectively. Corresponding median CRP levels were 1.31, 1.27, and 2.50 mg/dl (p <0.001). For the overall cohort, increasing age, low ejection fraction, revascularization, and elevated CRP were the strongest of 6 independent predictors for D/AMI. Among those presenting with SAP, CRP levels above the first tertile were associated with an adjusted hazard ratio of 1.8 (95% confidence interval [CI] 1.2 to 2.8, p <0.009) for D/AMI. After UAP, the hazard ratio was 2.7 (95% CI 1.4 to 5.0, p <0.002). However, when measured during hospitalization for AMI, CRP was not predictive of long-term outcome (hazard ratio 1.0 [95 % CI 0.5 to 1.7] p = 0.86). In conclusion, predischarge CRP levels are higher after AMI than after UAP or SAP. However, whereas CRP is strongly predictive of long-term D/AMI for patients presenting with SAP or UAP, it is not predictive shortly after AMI, suggesting that measurements should be delayed until the acute phase reaction is over and levels have returned to baseline.

Authors+Show Affiliations

University of Utah School of Medicine, Salt Lake City, Utah 84132-2401, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

11792332

Citation

Zebrack, James S., et al. "Usefulness of High-sensitivity C-reactive Protein in Predicting Long-term Risk of Death or Acute Myocardial Infarction in Patients With Unstable or Stable Angina Pectoris or Acute Myocardial Infarction." The American Journal of Cardiology, vol. 89, no. 2, 2002, pp. 145-9.
Zebrack JS, Anderson JL, Maycock CA, et al. Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death or acute myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. Am J Cardiol. 2002;89(2):145-9.
Zebrack, J. S., Anderson, J. L., Maycock, C. A., Horne, B. D., Bair, T. L., & Muhlestein, J. B. (2002). Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death or acute myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. The American Journal of Cardiology, 89(2), 145-9.
Zebrack JS, et al. Usefulness of High-sensitivity C-reactive Protein in Predicting Long-term Risk of Death or Acute Myocardial Infarction in Patients With Unstable or Stable Angina Pectoris or Acute Myocardial Infarction. Am J Cardiol. 2002 Jan 15;89(2):145-9. PubMed PMID: 11792332.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of high-sensitivity C-reactive protein in predicting long-term risk of death or acute myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. AU - Zebrack,James S, AU - Anderson,Jeffrey L, AU - Maycock,Chloe Allen, AU - Horne,Benjamin D, AU - Bair,Tami L, AU - Muhlestein,Joseph Brent, AU - ,, PY - 2002/1/17/pubmed PY - 2002/2/22/medline PY - 2002/1/17/entrez SP - 145 EP - 9 JF - The American journal of cardiology JO - Am J Cardiol VL - 89 IS - 2 N2 - High-sensitivity C-reactive protein (CRP), proposed as a new coronary risk marker, may reflect either an acute phase reaction or the level of chronic inflammation. Thus, CRP may be less predictive of long-term outcomes when measured after acute myocardial infarction (AMI) than after unstable angina pectoris (UAP) or stable angina pectoris (SAP). A total of 1,360 patients with severe coronary artery disease (>/=1 stenosis >/=70%) had CRP levels obtained at angiography. Presenting diagnoses were SAP (n = 599), UAP (n = 442), or AMI (n = 319). During follow-up (mean 2.8 years), death or nonfatal AMI (D/AMI) occurred in 19.5%, 16.1%, and 17.2% (p = NS) with SAP, UAP, and AMI, respectively. Corresponding median CRP levels were 1.31, 1.27, and 2.50 mg/dl (p <0.001). For the overall cohort, increasing age, low ejection fraction, revascularization, and elevated CRP were the strongest of 6 independent predictors for D/AMI. Among those presenting with SAP, CRP levels above the first tertile were associated with an adjusted hazard ratio of 1.8 (95% confidence interval [CI] 1.2 to 2.8, p <0.009) for D/AMI. After UAP, the hazard ratio was 2.7 (95% CI 1.4 to 5.0, p <0.002). However, when measured during hospitalization for AMI, CRP was not predictive of long-term outcome (hazard ratio 1.0 [95 % CI 0.5 to 1.7] p = 0.86). In conclusion, predischarge CRP levels are higher after AMI than after UAP or SAP. However, whereas CRP is strongly predictive of long-term D/AMI for patients presenting with SAP or UAP, it is not predictive shortly after AMI, suggesting that measurements should be delayed until the acute phase reaction is over and levels have returned to baseline. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/11792332/Usefulness_of_high_sensitivity_C_reactive_protein_in_predicting_long_term_risk_of_death_or_acute_myocardial_infarction_in_patients_with_unstable_or_stable_angina_pectoris_or_acute_myocardial_infarction_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002914901021907 DB - PRIME DP - Unbound Medicine ER -