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Journal of Cardiology, 2019. 74(1), 74-83, DOI: https://doi.org/10.1016/j.jjcc.2018.12.022
Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction
Dong Oh Kang, Yoonjee Park; Ji Hoon Seo; Myung Ho Jeong; Shung Chull Chae; Tae Hoon Ahn; Won Young Jang; Woohyeun Kim; Eun Jin Park; Byoung Geol Choi; Jin Oh Na; Cheol Ung Choi; Eung Ju Kim; Seung-Woon Rha; Chang Gyu Park; Hong Seog Seo
• The prognostic impact of baseline high sensitivity C-reactive protein (hs-CRP) was mostly confined to the first 6 months.
• High-intensity statin attenuated the prognostic impact of baseline hs-CRP elevation.
• Dose-dependent anti-inflammatory effect of statin is dominant over the first 6 months.
• High-intensity statin persistently improved outcome after first 6 months of acute myocardial infarction.
Elevated high sensitivity C-reactive protein (hs-CRP) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) has prognostic value for future cardiovascular events. This study aimed to ascertain a valid prognostic time-period for predicting cardiovascular outcome based on baseline hs-CRP in AMI patients undergoing successful PCI on statin therapy.
Overall, 4410 AMI patients were enrolled from the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry. Participants were divided into groups according to cut-off values of baseline hs-CRP (1.0, 3.0, and 10.0 mg/L) and statin therapy intensity. The primary outcome was 36-month major adverse cardiovascular events (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization. The secondary outcome was MACE developed 0–6, 6–12, and 12–36 months after AMI.
The overall incidence of 36-month MACE was significantly higher as baseline hs-CRP increased (by groups: 8.8% vs. 8.6% vs. 10.7% vs. 15.4%, log-rank p < 0.001). The prognostic effect of baseline hs-CRP was mostly confined to the first 6 months after AMI (0–6 months MACE by groups: 1.6% vs. 2.3% vs. 4.3% vs. 6.1%, log-rank p < 0.001) and attenuated in high-intensity statin users. Six months after AMI, this prognostic effect of baseline hs-CRP was remarkably reduced (6–12 month MACE by groups: 2.4% vs. 2.1% vs. 2.8% vs. 4.0%, log-rank p = 0.111, 12–36 month MACE by groups: 4.7% vs. 4.1% vs. 4.0% vs. 6.2%, log-rank p = 0.218); however, high-intensity statin treatment showed a consistent improvement in outcome. The observed time-dependent prognostic effects remained consistent following multivariate analysis.
The prognostic impact of elevated hs-CRP at baseline was most evident during the first 6 months after AMI; however, the use of high-intensity statin persistently improved the clinical outcome even after the resolution of inflammatory reactions.
- DOI: https://doi.org/10.1016/j.jjcc.2018.12.022
- ISBN or ISSN: 0914-5087
- 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
- This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.