TY - JOUR
T1 - Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction
AU - Kang, Dong Oh
AU - Park, Yoonjee
AU - Seo, Ji Hoon
AU - Jeong, Myung Ho
AU - Chae, Shung Chull
AU - Ahn, Tae Hoon
AU - Jang, Won Young
AU - Kim, Woohyeun
AU - Park, Eun Jin
AU - Choi, Byoung Geol
AU - Na, Jin Oh
AU - Choi, Cheol Ung
AU - Kim, Eung Ju
AU - Rha, Seung Woon
AU - Park, Chang Gyu
AU - Seo, Hong Seog
N1 - Funding Information:
This research was supported by grants from the National Research Foundation of Korea ( NRF-2016R1A2B3013825 ), the Ministry of Future Creation and Science of Korea ( 2018K000255 ), the Korea University Guro Hospital Grant ( O1600121 ), the Research of Korea Centers for Disease Control and Prevention ( 2013-E63005-02 ), and a grant from BK21 Plus Korea University Medical Science Graduate Program ( T1300516 ).
PY - 2019/7
Y1 - 2019/7
N2 - 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.
AB - 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.
KW - C-reactive protein
KW - Coronary artery disease
KW - Myocardial infarction
KW - Percutaneous coronary intervention
KW - Statins
UR - http://www.scopus.com/inward/record.url?scp=85061141143&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85061141143&partnerID=8YFLogxK
U2 - 10.1016/j.jjcc.2018.12.022
DO - 10.1016/j.jjcc.2018.12.022
M3 - Article
C2 - 30745001
AN - SCOPUS:85061141143
VL - 74
SP - 74
EP - 83
JO - Journal of Cardiology
JF - Journal of Cardiology
SN - 0914-5087
IS - 1
ER -