Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction

Dong Oh Kang, Yoonjee Park, Ji Hoon Seo, Myung Ho Jeong, Shung Chull Chae, Tae Hoon Ahn, Won Young Jang, Woohyeun Kim, Eun Jin Park, Byoung Geol Choi, Jin Oh Na, Cheol Ung Choi, Eung Ju Kim, Seung-Woon Rha, Chang Gyu Park, Hong Seog Seo

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2 Citations (Scopus)

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.

Original languageEnglish
JournalJournal of Cardiology
DOIs
Publication statusPublished - 2019 Jan 1

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Hydroxymethylglutaryl-CoA Reductase Inhibitors
C-Reactive Protein
Myocardial Infarction
Therapeutics
Percutaneous Coronary Intervention
National Institutes of Health (U.S.)
Korea
Registries
Multivariate Analysis

Keywords

  • C-reactive protein
  • Coronary artery disease
  • Myocardial infarction
  • Percutaneous coronary intervention
  • Statins

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction. / 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.

In: Journal of Cardiology, 01.01.2019.

Research output: Contribution to journalArticle

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. / Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction. In: Journal of Cardiology. 2019.
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title = "Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction",
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.",
keywords = "C-reactive protein, Coronary artery disease, Myocardial infarction, Percutaneous coronary intervention, Statins",
author = "Kang, {Dong Oh} and Yoonjee Park and Seo, {Ji Hoon} and Jeong, {Myung Ho} and Chae, {Shung Chull} and Ahn, {Tae Hoon} and Jang, {Won Young} and Woohyeun Kim and Park, {Eun Jin} and Choi, {Byoung Geol} and Na, {Jin Oh} and Choi, {Cheol Ung} and Kim, {Eung Ju} and Seung-Woon Rha and Park, {Chang Gyu} and Seo, {Hong Seog}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.jjcc.2018.12.022",
language = "English",
journal = "Journal of Cardiology",
issn = "0914-5087",
publisher = "Japanese College of Cardiology (Nippon-Sinzobyo-Gakkai)",

}

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

PY - 2019/1/1

Y1 - 2019/1/1

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

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U2 - 10.1016/j.jjcc.2018.12.022

DO - 10.1016/j.jjcc.2018.12.022

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JO - Journal of Cardiology

JF - Journal of Cardiology

SN - 0914-5087

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