Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction
- Authors
- Kang, Dong Oh; Park, Yoonjee; Seo, Ji Hoon; Jeong, Myung Ho; Chae, Shung Chull; Ahn, Tae Hoon; Jang, Won Young; Kim, Woohyeun; Park, Eun Jin; Choi, Byoung Geol; Na, Jin Oh; Choi, Cheol Ung; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Seo, Hong Seog
- Issue Date
- Jul-2019
- Publisher
- ELSEVIER SCIENCE BV
- Keywords
- C-reactive protein; Statins; Myocardial infarction; Percutaneous coronary intervention; Coronary artery disease
- Citation
- JOURNAL OF CARDIOLOGY, v.74, no.1, pp 74 - 83
- Pages
- 10
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF CARDIOLOGY
- Volume
- 74
- Number
- 1
- Start Page
- 74
- End Page
- 83
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/1871
- DOI
- 10.1016/j.jjcc.2018.12.022
- ISSN
- 0914-5087
1876-4738
- Abstract
- Background: Elevated high sensitivity C-reactive protein (hs-CRP) in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) has prognostic value for future cardiovascular events. This study aimed to ascertain a valid prognostic time-period for predicting cardiovascular outcome based on baseline hs-CRP in AMI patients undergoing successful PCI on statin therapy. Methods: Overall, 4410 AMI patients were enrolled from the Korea Acute Myocardial Infarction-National Institutes of Health (KAMIR-NIH) registry. Participants were divided into groups according to cut-off values of baseline hs-CRP (1.0, 3.0, and 10.0 mg/L) and statin therapy intensity. The primary outcome was 36-month major adverse cardiovascular events (MACE), a composite of all-cause mortality, any myocardial infarction, and repeat revascularization. The secondary outcome was MACE developed 0-6, 6-12, and 12-36 months after AMI. Results: The overall incidence of 36-month MACE was significantly higher as baseline hs-CRP increased (by groups: 8.8% vs. 8.6% vs. 10.7% vs. 15.4%, log-rank p < 0.001). The prognostic effect of baseline hs-CRP was mostly confined to the first 6 months after AMI (0-6 months MACE by groups: 1.6% vs. 2.3% vs. 4.3% vs. 6.1%, log-rank p < 0.001) and attenuated in high-intensity statin users. Six months after AMI, this prognostic effect of baseline hs-CRP was remarkably reduced (6-12 month MACE by groups: 2.4% vs. 2.1% vs. 2.8% vs. 4.0%, log-rank p = 0.111,12-36 month MACE by groups: 4.7% vs. 4.1% vs. 4.0% vs. 6.2%, log-rank p = 0.218); however, high-intensity statin treatment showed a consistent improvement in outcome. The observed time-dependent prognostic effects remained consistent following multivariate analysis. Conclusions: The prognostic impact of elevated hs-CRP at baseline was most evident during the first 6 months after AMI; however, the use of high-intensity statin persistently improved the clinical outcome even after the resolution of inflammatory reactions. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.
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