[入院时超敏C反应蛋白在急性心肌梗死直接经皮冠状动脉介入治疗患者中的意义]

[The significance of admission hs-CRP in patients undergoing primary percutaneous intervention for acute myocardial infarction].

作者信息

Cağli Kumral Ergün, Topaloğlu Serkan, Aras Dursun, Günel Emre Nuri, Ozlü Mehmet Fatih, Uygur Belma, Baysal Erkan, Sen Nihat

机构信息

Türkiye Yüksek Ihtisas Eğitim ve Araştirma Hastanesi Kardiyoloji Kliniği, Ankara, Turkey.

出版信息

Turk Kardiyol Dern Ars. 2009 Jan;37(1):19-25.

PMID:19225249

Abstract

OBJECTIVES

We evaluated the role of admission high-sensitivity C-reactive protein (hs-CRP) level in estimating myocardial perfusion and in-hospital adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

STUDY DESIGN

The study included 43 consecutive patients (34 males, 9 females; mean age 59+/-11 years) who underwent PCI for STEMI within six hours after the onset of symptoms. Coronary angiograms were evaluated with respect to TIMI flow grade, corrected TIMI frame count, and myocardial blush grade (MBG). Electrocardiograms obtained 90 min after PCI were analyzed for ST-segment resolution. In-hospital adverse events were recorded. hs-CRP level was measured by immunonephelometry in blood obtained immediately before PCI.

RESULTS

The mean hs-CRP level was 1.35+/-1.17 mg/dl. Based on the median hs-CRP value (0.98 mg/dl), 22 patients with a low hs-CRP level had a lower frequency of hypertension (p=0.047), decreased TIMI frame counts of the left anterior descending (p=0.010) and circumflex (p=0.033) arteries, a higher rate of ST resolution (p=0.000), improved MBG (p=0.015), and shorter hospitalization (p=0.028). Adverse events occurred in six patients (14%), in five of whom (5/21) the hs-CRP level was above 0.98 mg/dl. hs-CRP was significantly correlated with corrected TIMI frame counts of the left anterior descending (r=0.388, p=0.01) and circumflex arteries (r=0.336, p=0.027), length of hospitalization (r=0.357, p=0.019), and inversely correlated with MBG (r=-0.415, p=0.006). In multivariate regression analysis, hs-CRP was found to be an independent predictor of ST resolution (p=0.008). ROC analysis showed that a higher level of hs-CRP than 0.88 mg/dl predicted poor MBG with 73% sensitivity and 31% specificity (95% CI 0.577-0.899, p=0.01).

CONCLUSION

In STEMI patients undergoing primary PCI, high levels of admission hs-CRP are associated with poor myocardial perfusion and longer hospitalization.

摘要

目的

我们评估了入院时高敏C反应蛋白（hs-CRP）水平在估计急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗（PCI）时的心肌灌注及院内不良事件中的作用。

研究设计

本研究纳入了43例连续患者（34例男性，9例女性；平均年龄59±11岁），这些患者在症状发作后6小时内接受了STEMI的PCI治疗。对冠状动脉造影评估TIMI血流分级、校正TIMI帧数和心肌 blush分级（MBG）。分析PCI术后90分钟获得的心电图的ST段回落情况。记录院内不良事件。在PCI前即刻采集的血液中通过免疫比浊法测定hs-CRP水平。

结果

hs-CRP平均水平为1.35±1.17mg/dl。基于hs-CRP中位数（0.98mg/dl），22例hs-CRP水平低的患者高血压发生率较低（p = 0.047），左前降支（p = 0.010）和回旋支（p = 0.033）的TIMI帧数减少，ST段回落率较高（p = 0.000），MBG改善（p = 0.015），住院时间较短（p = 0.028）。6例患者（14%）发生不良事件，其中5例（5/21）hs-CRP水平高于0.98mg/dl。hs-CRP与左前降支（r = 0.388，p = 0.01）和回旋支的校正TIMI帧数（r = 0.336，p = 0.027）、住院时间（r = 0.357，p = 0.019）显著相关，与MBG呈负相关（r = -0.415，p = 0.006）。在多因素回归分析中，发现hs-CRP是ST段回落的独立预测因子（p = 0.008）。ROC分析显示，hs-CRP水平高于0.88mg/dl预测MBG差的敏感性为73%，特异性为31%（95%CI 0.577 - 0.899，p = 0.01）。