Brzezinski Rafael Y, Melloul Ariel, Berliner Shlomo, Goldiner Ilana, Stark Moshe, Rogowski Ori, Banai Shmuel, Shenhar-Tsarfaty Shani, Shacham Yacov
Internal Medicine "C", "D", and "E", Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
Department of Clinical Laboratories, Tel Aviv Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel.
J Clin Med. 2022 Apr 27;11(9):2453. doi: 10.3390/jcm11092453.
Elevated concentrations of C-reactive protein (CRP) early during an acute coronary syndrome (ACS) may reflect the magnitude of the inflammatory response to myocardial damage and are associated with worse outcome. However, the routine measurement of both CRP and cardiac troponin simultaneously in the setting of ST-segment myocardial infarction (STEMI) is not used broadly. Here, we sought to identify and characterize individuals who are prone to an elevated inflammatory response following STEMI by using a combined CRP and troponin test (CTT) and determine their short- and long-term outcome. We retrospectively examined 1186 patients with the diagnosis of acute STEMI, who had at least two successive measurements of combined CRP and cardiac troponin (up to 6 h apart), all within the first 48 h of admission. We used Chi-Square Automatic Interaction Detector (CHAID) tree analysis to determine which parameters, timing (baseline vs. serial measurements), and cut-offs should be used to predict mortality. Patients with high CRP concentrations (above 90th percentile, >33 mg/L) had higher 30 day and all-cause mortality rates compared to the rest of the cohort, regardless of their troponin test status (above or below 118,000 ng/L); 14.4% vs. 2.7%, p < 0.01. Furthermore, patients with both high CRP and high troponin levels on their second measurement had the highest 30-day mortality rates compared to the rest of the cohort; 21.4% vs. 3.7%, p < 0.01. These patients also had the highest all-cause mortality rates after a median follow-up of 4.5 years compared to the rest of the cohort; 42.9% vs. 12.7%, p < 0.01. In conclusion, serial measurements of both CRP and cardiac troponin might detect patients at increased risk for short-and long-term mortality following STEMI. We suggest the future use of the combined CTT as a potential early marker for inflammatory-prone patients with worse outcomes following ACS. This sub-type of patients might benefit from early anti-inflammatory therapy such as colchicine and anti-interleukin-1ß agents.
急性冠状动脉综合征（ACS）早期C反应蛋白（CRP）浓度升高可能反映了对心肌损伤的炎症反应程度，并与更差的预后相关。然而，在ST段抬高型心肌梗死（STEMI）情况下同时常规检测CRP和心肌肌钙蛋白的做法并未广泛应用。在此，我们试图通过联合CRP和肌钙蛋白检测（CTT）来识别和表征STEMI后易于出现炎症反应升高的个体，并确定其短期和长期预后。我们回顾性研究了1186例诊断为急性STEMI的患者，这些患者在入院的头48小时内至少连续两次（间隔最多6小时）检测了联合CRP和心肌肌钙蛋白。我们使用卡方自动相互作用检测器（CHAID）树分析来确定应使用哪些参数、检测时间（基线与系列测量）以及临界值来预测死亡率。CRP浓度高（高于第90百分位数，>33mg/L）的患者与队列中的其他患者相比，30天和全因死亡率更高，无论其肌钙蛋白检测结果（高于或低于118,000ng/L）如何；分别为14.4%和2.7%，p<0.01。此外，第二次检测时CRP和肌钙蛋白水平均高的患者与队列中的其他患者相比，30天死亡率最高；分别为21.4%和3.7%，p<0.01。与队列中的其他患者相比，在中位随访4.5年后，这些患者的全因死亡率也最高；分别为42.9%和12.7%，p<0.01。总之，连续检测CRP和心肌肌钙蛋白可能会发现STEMI后短期和长期死亡风险增加的患者。我们建议未来将联合CTT用作ACS后预后较差的易炎症患者的潜在早期标志物。这类患者可能会从秋水仙碱和抗白细胞介素-1β药物等早期抗炎治疗中获益。
