Correlations between severity of coronary atherosclerosis and persistent elevation of circulating C-reactive protein levels 30 days after an acute myocardial infarction

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Introduction: We aimed to assess the relationships between the persistence of elevated circulating levels of hs-CRP, a powerful inflammatory marker, determined at 30 days after an acute myocardial infarction (AMI), and the characteristics of the pre-existing coronary lesions. Material and methods: The study included 83 consecutive patients 30 days post AMI, who were subjected to coronary angiography and primary PCI. The patients were divided into two groups according to their hsCRP levels at 30 days after AMI: group 1 included 35 low-risk patients, with hsCRP levels <2 mg/l, and group 2 included 48 high-risk patients, with hsCRP levels >2 mg/l. Results: Angiographic analysis revealed the presence of a multivascular disease in 48.5% of the patients in group 1 versus 72.9% of the patients in group 2 (p=0.037). The Syntax scores for groups 1 and 2 were 22.2 +/- 6.6 and 27.07+/-0.94, respectively (p=0.001), and these values were significantly correlated with the hsCRP values (r=0.56, p<0.0001). LAD culprit lesions were found in 47.9% of the patients in group 1 and 20% of the patients in group 2 (p=0.01), and 42.8% of the group 1 patients and 83.3% of the group 2 patients had at least one significant stenosis in the LAD (p=0.0002). The ejection fraction at 30 days was significantly lower in the patients with elevated levels of hsCRP (52.91+/-4.03 vs 49.04+/-5.74, p=0.001), showing an inverse correlation with hsCRP levels (r=-0.52, p<0.0001). Conclusions: A more severe coronary artery disease was associated with am increased inflammatory status in the postinfarction phase, as evidenced by the high levels of circulating hsCRP. hsCRP can help for risk stratification in post AMI patients by identifying the subsets of patients who are at risk based on persistent elevated circulating levels of hsCRP at 30 days after infarction.

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