University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria.
Int J Cardiol. 2021 Sep 1;338:30-36. doi: 10.1016/j.ijcard.2021.06.023. Epub 2021 Jun 18.
The role of C-reactive protein velocity (CRPv) as an early and sensitive marker of an excessive inflammatory response in the setting of acute ST-elevation myocardial infarction (STEMI) is only poorly understood. The aim of this study was to investigate, in patients with STEMI treated with primary percutaneous coronary intervention (PCI), the association of CRPv with microvascular infarct pathology.
This prospective cohort study included a total of 316 patients with STEMI undergoing PCI. CRPv was defined as the difference between CRP 24 ± 8 h and CRP at hospital admission, divided by the time (in h) that have passed during the two examinations. The association of biomarker levels with cardiac magnetic resonance (CMR)-determined microvascular obstruction (MVO) was evaluated. CMR was performed at a median of 3 [interquartile range 2-4] days after PCI. After adjustment for cardiac troponin T (cTnT), anterior infarction and TIMI flow pre and post-PCI, CRPv (odds ratio 2.70, 95% confidence interval (CI) 1.54-4.73; p = 0.001) remained significantly associated with the occurrence of MVO. CRPv (area under the curve [AUC] 0.76, 95% CI 0.71-0.81; p < 0.001) was a better predictor for MVO compared to 24 h CRP (AUC difference: 0.03, p = 0.002). The addition of CRPv to peak cTnT resulted in a higher AUC for MVO prediction than peak cTnT alone (AUC 0.86, 95% CI 0.82-0.90; p < 0.001 vs. AUC 0.84, 95% CI 0.79-0.88; p < 0.001. AUC difference: 0.02, p = 0.042).
In patients with STEMI treated with primary PCI, CRPv was associated with microvascular infarct pathology with a predictive value incremental to cTnT, suggesting CRPv as an early and sensitive biomarker for more severe infarct pathology and outcome.
C 反应蛋白速度（CRPv）作为急性 ST 段抬高型心肌梗死（STEMI）患者过度炎症反应的早期和敏感标志物的作用知之甚少。本研究旨在探讨接受直接经皮冠状动脉介入治疗（PCI）的 STEMI 患者中，CRPv 与微血管梗塞病理学的关系。
这项前瞻性队列研究共纳入 316 例接受 PCI 的 STEMI 患者。CRPv 定义为 CRP 24±8 h 与入院时 CRP 之间的差异，除以两次检查之间经过的时间（h）。评估生物标志物水平与心脏磁共振（CMR）确定的微血管阻塞（MVO）的关系。在 PCI 后中位数 3[四分位距 2-4]天进行 CMR。在调整心脏肌钙蛋白 T（cTnT）、前壁梗死和 TIMI 血流前和后 PCI 后，CRPv（比值比 2.70，95%置信区间（CI）1.54-4.73；p=0.001）与 MVO 的发生仍显著相关。CRPv（曲线下面积[AUC]0.76，95%CI 0.71-0.81；p<0.001）比 24 h CRP（AUC 差值：0.03，p=0.002）更能预测 MVO。与单独使用峰值 cTnT 相比，将 CRPv 添加到峰值 cTnT 可提高 MVO 预测的 AUC（AUC 0.86，95%CI 0.82-0.90；p<0.001 与 AUC 0.84，95%CI 0.79-0.88；p<0.001。AUC 差值：0.02，p=0.042）。
在接受直接 PCI 治疗的 STEMI 患者中，CRPv 与微血管梗塞病理学相关，其预测价值高于 cTnT，提示 CRPv 是一种早期和敏感的生物标志物，可预测更严重的梗塞病理学和预后。
