Hong Young Joon, Mintz Gary S, Kim Sang Wook, Okabe Teruo, Bui Anh B, Pichard Augusto D, Satler Lowell F, Waksman Ron, Weissman Neil J
Cardiovascular Research Institute/Medstar Research Institute, Washington Hospital Center, Washington, DC, USA.
J Invasive Cardiol. 2008 Sep;20(9):428-35.
Ruptured plaques are associated with elevated C-reactive protein (CRP) that, in turn, are associated with a poor prognosis in acute myocardial infarction (AMI) patients.
The purpose of this study was to evaluate the impact of plaque rupture and elevated CRP on major adverse cardiac events (MACE) in patients with AMI treated with coronary stenting.
We used pre-intervention intravascular ultrasound (IVUS) to evaluate infarct-related arteries in 72 AMI patients treated with coronary stenting to study the impact of plaque rupture and CRP levels on MACE.
Infarct-related artery plaque rupture was observed in 30 patients (42%), and multiple infarct-related artery plaque ruptures were observed in 10 patients (14%). The CRP level was higher in patients with plaque rupture than in those without plaque rupture (31.3 +/- 20.3 vs. 4.2 +/- 5.8 mg/l; p < 0.001). Patients with elevated CRP levels had more plaque rupture and more multiple plaque ruptures than the normal CRP group (26/42 [62%] vs. 4/30 [13%]; p < 0.001, and 10/42 [24%] vs. 0/30 [0%]; p = 0.004, respectively). Plaque rupture and ST-segment elevation MI independently predicted CRP elevation (Hazard ratio [HR] = 5.329; p < 0.001 and HR = 3.790; p = 0.032, respectively). At 1-year follow up, MACE occurred in 9 plaque-rupture patients (30%), in 5 non-plaque rupture patients (12%) and in 29% of elevated CRP patients versus 7% of normal CRP patients. Patients with elevated CRP plus plaque rupture had more MACE than patients with normal CRP and no plaque rupture (31% vs. 4%; p = 0.010). In the multivariate analysis, an elevated CRP was the only independent predictor of MACE (HR = 6.561; p = 0.012).
Plaque rupture and elevated CRP were associated with poor prognosis; however, an elevated CRP was the only independent predictor of 1-year MACE in AMI patients treated with coronary stenting.
破裂斑块与C反应蛋白（CRP）升高相关，而CRP升高又与急性心肌梗死（AMI）患者的不良预后相关。
本研究旨在评估斑块破裂和CRP升高对接受冠状动脉支架置入术的AMI患者主要不良心脏事件（MACE）的影响。
我们使用干预前血管内超声（IVUS）评估72例接受冠状动脉支架置入术的AMI患者的梗死相关动脉，以研究斑块破裂和CRP水平对MACE的影响。
30例患者（42%）观察到梗死相关动脉斑块破裂，10例患者（14%）观察到多处梗死相关动脉斑块破裂。斑块破裂患者的CRP水平高于无斑块破裂患者（31.3±20.3 vs. 4.2±5.8 mg/l；p<0.001）。CRP水平升高的患者比正常CRP组有更多的斑块破裂和更多的多处斑块破裂（26/42 [62%] vs. 4/30 [13%]；p<0.001，以及10/42 [24%] vs. 0/30 [0%]；p = 0.004）。斑块破裂和ST段抬高型心肌梗死独立预测CRP升高（风险比[HR]=5.329；p<0.001和HR = 3.790；p = 0.032）。在1年随访时，9例斑块破裂患者（30%）、5例非斑块破裂患者（12%）发生MACE，CRP升高患者中29%发生MACE，而正常CRP患者中为7%。CRP升高加斑块破裂的患者比正常CRP且无斑块破裂的患者有更多的MACE（31% vs. 4%；p = 0.010）。在多变量分析中，CRP升高是MACE的唯一独立预测因素（HR = 6.561；p = 0.012）。
斑块破裂和CRP升高与不良预后相关；然而，CRP升高是接受冠状动脉支架置入术的AMI患者1年MACE的唯一独立预测因素。
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