Comparison of high-sensitivity C-reactive protein vs. C-reactive protein for diagnostic accuracy and prediction of mortality in patients with acute myocardial infarction.

Autor:	Hofer F; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Perkmann T; Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria., Gager G; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.; Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria., Winter MP; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Niessner A; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Hengstenberg C; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria., Siller-Matula JM; Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.; Department of Experimental and Clinical Pharmacology, Centre for Preclinical Research and Technology (CEPT), Medical University of Warsaw, Warsaw, Poland.
Jazyk:	angličtina
Zdroj:	Annals of clinical biochemistry [Ann Clin Biochem] 2021 Jul; Vol. 58 (4), pp. 342-349. Date of Electronic Publication: 2021 Mar 28.
DOI:	10.1177/00045632211004651
Abstrakt:	Background: The role of chronic inflammation in the pathogenesis of atherosclerosis has been unequivocally proven. However, the prognostic impact of C-reactive protein, a marker of inflammatory response in patients with acute myocardial infarction has not been fully clarified. Furthermore, there is no direct comparison of the diagnostic accuracy of C-reactive protein and high sensitivity C-reactive protein in the acute myocardial infarction population. Methods: In this prospective observational cohort study, 344 patients with acute myocardial infarction were enrolled. All-cause mortality was a primary endpoint. Patients were followed prospectively for a median of six years. Results: The correlation between high sensitivity C-reactive protein and C-reactive protein ( r  = 0.99; P  < 0.001) and the diagnostic accuracy (98.6%) was high. The ROC analysis revealed that C-reactive protein and high sensitivity C-reactive protein had a low AUC for prediction of mortality (C-reactive protein: 0.565, 95% CI [0.462-0.669], vs. high sensitivity C-reactive protein: 0.572, 95% CI [0.470-0.675]) or major adverse cardiac events (C-reactive protein: AUC 0.607, 95% CI [0.405-0.660], vs. high sensitivity C-reactive protein: AUC 0.526, 95% CI [0.398-0.653]) when assessed at time point of acute myocardial infarction. In contrast, longitudinal inflammatory risk assessment with serial C-reactive protein measurements in the stable phase of the disease revealed a 100% specificity, 100% negative predictive value, 32% sensitivity and 12% positive predictive value of C-reactive protein to predict long-term mortality. The Kaplan Meier analysis showed a significant survival benefit for patients at low residual inflammatory risk ( P  =   0.014). Conclusion: C-reactive protein and high sensitivity C-reactive protein provide a similar diagnostic accuracy, highlighting that C-reactive protein might replace high sensitivity C-reactive protein in routine assessments. Furthermore, low inflammatory status during the stable phase after acute myocardial infarction predicts favourable six-year survival.
Databáze:	MEDLINE
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