持续性ST段抬高型急性心肌梗死患者入院时血清C反应蛋白水平与生存率

Admission C-reactive protein serum levels and survival in patients with acute myocardial infarction with persistent ST elevation.

作者信息

Canale Maria L, Stroppa Stefano, Caravelli Paolo, Petronio Anna S, Mariotti Rita, Mariani Mario, Balbarini Alberto, Barsotti Antonio

机构信息

Division of Cardiology, Cardio-Thoracic Department, Cisanello Hospital, University of Pisa, Pisa, Italy.

出版信息

Coron Artery Dis. 2006 Dec;17(8):693-8. doi: 10.1097/01.mca.0000236286.48812.8c.

DOI:10.1097/01.mca.0000236286.48812.8c

PMID:17119378

Abstract

OBJECTIVE

To evaluate the prognostic value of a single and early determination of high sensitivity C-reactive protein levels at admittance in patients with acute myocardial infarction with persistent ST elevation.

PATIENTS AND METHODS

We evaluated high-sensitivity C-reactive protein levels in 247 consecutive acute myocardial infarction with persistent ST elevation patients at admittance. Patients were monitored for the occurrence of major adverse cardiovascular events.

RESULTS

Mean follow-up was 26 months. High C-reactive protein levels were principally associated with age > or = 65 years (P=0.01), diabetes (P=0.03) and reduced left ventricle ejection fraction (P=0.048). We observed a significant C-reactive protein level difference between the major adverse cardiovascular event-free group and the major adverse cardiovascular event group (28.2+/-21.9 vs. 47.7+/-31.9 mg/l, P=0.03), between deceased patients group (vs. 81.5+/-51.8 mg/l, P<0.001) and early deaths (vs. 129.5+/-71.9 mg/l, P<0.001). Kaplan-Meier plots for survival and major adverse cardiovascular event occurrence showed a significant separation (P=0.01 and 0.002 by log-rank test, respectively) between high and low C-reactive protein level groups. C-reactive protein levels were independent risk predictors of major adverse cardiovascular events (odds ratio 2.931, 95% confidence interval 1.512-5.893; P=0.046) and death (odds ratio 5.068, 95% confidence interval 2.056-20.195; P=0.04). Patients with high C-reactive protein levels and age > or = 65 years were at highest risk for major adverse cardiovascular event occurrence (odds ratio 5.658, 95% confidence interval 2.898-6.249; P=0.022) and death (odds ratio 8.120, 95% confidence interval 5.656-22.729; P=0.03).

CONCLUSIONS

High C-reactive protein levels identify patients with a worse prognosis after acute myocardial infarction with persistent ST elevation. The evaluation of C-reactive protein and age may provide a tool to select high-risk patients.

摘要

目的

评估急性ST段持续抬高型心肌梗死患者入院时单次早期测定高敏C反应蛋白水平的预后价值。

患者与方法

我们评估了247例连续的急性ST段持续抬高型心肌梗死患者入院时的高敏C反应蛋白水平。对患者进行主要不良心血管事件发生情况的监测。

结果

平均随访26个月。高C反应蛋白水平主要与年龄≥65岁（P=0.01）、糖尿病（P=0.03）及左心室射血分数降低（P=0.048）相关。我们观察到主要不良心血管事件未发生组与主要不良心血管事件组之间C反应蛋白水平存在显著差异（28.2±21.9 vs. 47.7±31.9mg/L，P=0.03），死亡患者组（vs. 81.5±51.8mg/L，P<0.001）与早期死亡患者组（vs. 129.5±71.9mg/L，P<0.001）之间也存在显著差异。生存及主要不良心血管事件发生情况的Kaplan-Meier曲线显示，高、低C反应蛋白水平组之间存在显著分离（对数秩检验P值分别为0.01和0.002）。C反应蛋白水平是主要不良心血管事件（比值比2.931，95%置信区间1.512 - 5.893；P=0.046）和死亡（比值比5.068，95%置信区间2.056 - 20.195；P=0.04）的独立风险预测因子。C反应蛋白水平高且年龄≥65岁的患者发生主要不良心血管事件（比值比5.658，95%置信区间2.898 - 6.249；P=0.022）和死亡（比值比8.120，95%置信区间5.656 - 22.729；P=0.03）的风险最高。