Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
권호 표지
DOI QR코드

DOI QR Code

Prognostic Impact of Baseline High-Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention Based on Body Mass Index

  • Ahmed, Khurshid (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Jeong, Myung-Ho (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Chakraborty, Rabin (Department of Cardiology, Apollo Gleneagles Hospital) ;
  • Cho, Kyung-Hoon (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Sim, Doo-Sun (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Hong, Young-Joon (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Ahn, Young-Keun (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Hachinohe, Daisuke (Department of Cardiovascular Medicine, Chonnam National University College of Medicine) ;
  • Cho, Myeong-Chan (Department of Cardiology, Chungbuk National University College of Medicine) ;
  • Kim, Chong-Jin (Department of Cardiovascular Medicine, Kyunghee University College of Medicine) ;
  • Kim, Young-Jo (Department of Cardiology, Yeungnam University College of Medicine)
  • Published : 2012.03.31
⟨ Previous Next ⟩

Abstract

Background and Objectives: Serum high sensitivity C-reactive protein (hs-CRP) is a marker of inflammation and may lead to the development of atherosclerosis, adversely affecting mortality. The aim of this study was to evaluate the relationship between baseline hs-CRP level and 12-month clinical outcomes in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) according to their body mass index (BMI) status. Subjects and Methods: Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to September 2008, a total of 8174 consecutive AMI patients were studied. Cox proportional hazard model revealed that higher baseline levels of hs-CRP was associated with 12-month all-cause mortality (p=0.045). To further understand this association, patients were divided into 3 groups based on their body mass index: 1) overweight/obese, 2) normal weight, and 3) underweight patients. Then each group was stratified into quartiles based on their hs-CRP. Results: In overweight/obese patients, Cox model showed significant association of hs-CRP with 12-month mortality when adjusted for age and gender (p<0.001), however, after adjustment with multiple covariates, mortality was highest in the 4th quartile {HR 2.382, (1.079-5.259), p=0.032} though statistically insignificant (p=0.172). We observed no significant association of serum hs-CRP with 12-month mortality in normal weight (p=0.681) and underweight (p=0.760) patients. Conclusion: Higher baseline hs-CRP level (${\geq}$4.08 mg/dL) in overweight/obese AMI patients showed significant association with 12-month all-cause mortality independent of other prognostic markers.

Keywords

References

  1. Koenig W, Khuseyinova N, Baumert J, Meisinger C. Prospective study of high-sensitivity C-reactive protein as a determinant of mortality: results from the MONICA/KORA Augsburg Cohort Study, 1984-1998. Clin Chem 2008;54:335-42. https://doi.org/10.1373/clinchem.2007.100271
  2. Marsik C, Kazemi-Shirazi L, Schickbauer T, et al. C-reactive protein and all-cause mortality in a large hospital-based cohort. Clin Chem 2008; 54:343-9. https://doi.org/10.1373/clinchem.2007.091959
  3. Kang WY, Jeong MH, Ahn YK, et al. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in STsegment elevation myocardial infarction. J Cardiol 2010;55:84-91. https://doi.org/10.1016/j.jjcc.2009.10.004
  4. Devaraj S, O'Keefe G, Jialal I. Defining the proinflammatory phenotype using high sensitive C-reactive protein levels as the biomarker. J Clin Endocrinol Metab 2005;90:4549-54. https://doi.org/10.1210/jc.2005-0069
  5. Noh HJ, Kwon NH, Joo SB. Severity of coronary atherosclerosis; influence of mtabolic syndrome risk factor clustering and hs-CRP. Korean Circ J 2006;36:802-8.
  6. Sim DS, Jeong MH, Kang JC. Current management of acute myocardial infarction: experience from the Korea Acute Myocardial Infarction Registry. J Cardiol 2010;56:1-7. https://doi.org/10.1016/j.jjcc.2010.04.002
  7. Lee KH, Jeong MH, Ahn YK. Sex differences of the clinical characteristics and early management in the Korea Acute Myocardial Infarction Registry. Korean Circulation J 2007;37:64-71. https://doi.org/10.4070/kcj.2007.37.2.64
  8. Sim DS, Kim JH, Jeong MH. Differences in clinical outcomes between patients with ST-elevation versus non-ST-elevation acute myocardial infarction in Korea. Korean Circ J 2009;39:297-303. https://doi.org/10.4070/kcj.2009.39.8.297
  9. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet 2004;363:157-63. https://doi.org/10.1016/S0140-6736(03)15268-3
  10. Apple FS, Wu AH, Jaffe AS. European Society of Cardiology and American College of Cardiology guidelines for redefinition of myocardial infarction: how to use existing assays clinically and for clinical trials. Am Heart J 2002;144:981-6. https://doi.org/10.1067/mhj.2002.124048
  11. Kini AS. Coronary angiography, lesion classification and severity assessment. Cardiol Clin 2006;24:153-62, v. https://doi.org/10.1016/j.ccl.2006.04.002
  12. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med 2002;347:1557-65. https://doi.org/10.1056/NEJMoa021993
  13. Ridker PM, Buring JE, Cook NR, Rifai N. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8-year follow-up of 14 719 initially healthy American women. Circulation 2003; 107:391-7. https://doi.org/10.1161/01.CIR.0000055014.62083.05
  14. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003;107:363-9. https://doi.org/10.1161/01.CIR.0000053730.47739.3C
  15. Yudkin JS, Stehouwer CD, Emeis JJ, Coppack SW. C-reactive protein in healthy subjects: associations with obesity, insulin resistance, and endothelial dysfunction: a potential role for cytokines originating from adipose tissue? Arterioscler Thromb Vasc Biol 1999;19:972-8. https://doi.org/10.1161/01.ATV.19.4.972
  16. Bahceci M, Gokalp D, Bahceci S, Tuzcu A, Atmaca S, Arikan S. The correlation between adiposity and adiponectin, tumor necrosis factor alpha, interleukin-6 and high sensitivity C-reactive protein levels: is adipocyte size associated with inflammation in adults? J Endocrinol Invest 2007;30:210-4. https://doi.org/10.1007/BF03347427
  17. Bastard JP, Maachi M, Van Nhieu JT, et al. Adipose tissue IL-6 content correlates with resistance to insulin activation of glucose uptake both in vivo and in vitro. J Clin Endocrinol Metab 2002;87:2084-9. https://doi.org/10.1210/jc.87.5.2084
  18. Lagathu C, Bastard JP, Auclair M, Maachi M, Capeau J, Caron M. Chronic interleukin-6 (IL-6) treatment increased IL-6 secretion and induced insulin resistance in adipocyte: prevention by rosiglitazone. Biochem Biophys Res Commun 2003;311:372-9. https://doi.org/10.1016/j.bbrc.2003.10.013
  19. Verma S, Li SH, Badiwala MV, et al. Endothelin antagonism and interleukin- 6 inhibition attenuate the proatherogenic effects of C-reactive protein. Circulation 2002;105:1890-6. https://doi.org/10.1161/01.CIR.0000015126.83143.B4
  20. Wang CH, Li SH, Weisel RD, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation 2003; 107:1783-90. https://doi.org/10.1161/01.CIR.0000061916.95736.E5
  21. Visser M, Bouter LM, McQuillan GM, Wener MH, Harris TB. Elevated C-reactive protein levels in overweight and obese adults. JAMA 1999; 282:2131-5. https://doi.org/10.1001/jama.282.22.2131
  22. De Sutter J, de Buyzere M, Gheeraert P, et al. Fibrinogen and C-reactive protein on admission as markers of final infarct size after primary angioplasty for acute myocardial infarction. Atherosclerosis 2001;157: 189-96. https://doi.org/10.1016/S0021-9150(00)00703-6
  23. Saito M, Ishimitsu T, Minami J, Ono H, Ohrui M, Matsuoka H. Relations of plasma high-sensitivity C-reactive protein to traditional cardiovascular risk factors. Atherosclerosis 2003;167:73-9. https://doi.org/10.1016/S0021-9150(02)00380-5
  24. Ryu SY, Lee YS, Park J, Kang MG, Kim KS. Relations of plasma highsensitivity C-reactive protein to various cardiovascular risk factors. J Korean Med Sci 2005;20:379-83. https://doi.org/10.3346/jkms.2005.20.3.379
  25. Araujo JP, Lourenco P, Azevedo A, et al. Prognostic value of high-sensitivity C-reactive protein in heart failure: a systematic review. J Card Fail 2009;15:256-66. https://doi.org/10.1016/j.cardfail.2008.10.030
  26. Bursi F, Weston SA, Killian JM, Gabriel SE, Jacobsen SJ, Roger VL. C-reactive protein and heart failure after myocardial infarction in the community. Am J Med 2007;120:616-22. https://doi.org/10.1016/j.amjmed.2006.07.039
  27. Alonso-Martinez JL, Llorente-Diez B, Echegaray-Agara M, Olaz-Preciado F, Urbieta-Echezarreta M, González-Arencibia C. C-reactive protein as a predictor of improvement and readmission in heart failure. Eur J Heart Fail 2002;4:331-6. https://doi.org/10.1016/S1388-9842(02)00021-1
  28. Asakura M, Ueda Y, Yamaguchi O, et al. Extensive development of vulnerable plaques as a pan-coronary process in patients with myocardial infarction: an angioscopic study. J Am Coll Cardiol 2001;37:1284-8. https://doi.org/10.1016/S0735-1097(01)01135-4
  29. Tataru MC, Heinrich J, Junker R, et al. C-reactive protein and the severity of atherosclerosis in myocardial infarction patients with stable angina pectoris. Eur Heart J 2000;21:1000-8. https://doi.org/10.1053/euhj.1999.1981
  30. Nissen SE, Tuzcu EM, Schoenhagen P, et al. Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease. N Engl J Med 2005;352:29-38. https://doi.org/10.1056/NEJMoa042000
  31. Rao AD, Milbrandt EB. To JUPITER and beyond: statins, inflammation, and primary prevention. Crit Care 2010;14:310. https://doi.org/10.1186/cc9006
  32. Sever PS, Dahlof B, Poulter NR, et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial: Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003;361:1149-58 https://doi.org/10.1016/S0140-6736(03)12948-0
  33. De Beer FC, Hind CR, Fox KM, Allan RM, Maseri A, Pepys MB. Measurement of serum C-reactive protein concentration in myocardial ischaemia and infarction. Br Heart J 1982;47:239-43. https://doi.org/10.1136/hrt.47.3.239

Cited by

  1. A Control-Theoretic Model of Atherosclerosis vol.20, pp.3, 2012, https://doi.org/10.3390/ijms20030785