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Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction.

ABSTRACT: Background: High sensitivity CRP (hs-CRP) has attracted intense interest in risk assessment. We aimed to explore its prognostic value in patients with acute myocardial infarction (AMI). Methods and Results: We enrolled 4,504 consecutive AMI patients in this prospective cohort study. The associations between hs-CRP levels with the incidence of in-hospital HF was evaluated by logistic regression analysis. The association between hs-CRP levels and the cumulative incidence of HF after hospitalization were evaluated by Fine-Gray proportional sub-distribution hazards models, accounting for death without HF as competing risk. Cox proportional hazards regression models were constructed to estimate the association between hs-CRP levels and the risk of all-cause mortality. Over a median follow-up of 1 year, 1,112 (24.7%) patients developed in-hospital HF, 571 (18.9%) patients developed HF post-discharge and 262 (8.2%) patients died. In the fully adjusted model, the risk of in-hospital heart failure (HF) [95% confidence intervals (CI)] among those patients with hs-CRP values in quartile 3 (Q3) and Q4 were 1.36 (1.05-1.77) and 1.41 (1.07-1.85) times as high as the risk among patients in Q1 (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.33 (1.00-1.76) and 1.80 times (1.37-2.36) as high as the risk of HF post-discharge compared with patients in Q1 respectively (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.74 (1.08-2.82) and 2.42 times (1.52-3.87) as high as the risk of death compared with patients in Q1 respectively (p trend < 0.001). Conclusions: Hs-CRP was found to be associated with the incidence of in-hospital HF, HF post-discharge and all-cause mortality in patients with AMI.

SUBMITTER: Zhang X

PROVIDER: S-EPMC8181755 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveThe purpose of this study was to examine the level of serum FGF21 in acute myocardial infarction (AMI) and to explore the association between serum FGF21 and major adverse cardiovascular events in AMI patients.MethodsA total of 238 Chinese patients were recruited for this study between January 2016 and June 2016, including 183 AMI patients and 55 patients without AMI were enrolled in this study. The level of serum FGF21 was measured by ELISA. Patients were followed-up after admission using a standardized protocol that included Outpatient follow-up and telephone contacts to record the Major Adverse Cardiovascular Events (MACEs). Finally, 165 patients were enrolled and followed up during the period of 24 months.ResultsCirculating FGF21 level was elevated in the AMI patients compared to control (P < 0.05). Multivariate linear regression analysis showed that cTnI (? = -0.001, 95% CI = 0.021-0.001, P = 0.002), fibrinogen (? = -0.055, 95% CI = 0.098-0.013, P = 0.011) and hyperlipidemia (? = 0.129, 95% CI = 0.014-0.243, P = 0.011) were the independent risk factors for the serum of FGF21 in AMI patients. After follow-up, A Kaplan-Meier analysis showed that the all-cause mortality rate was not significantly different between the two groups (P = 0.4146). Meanwhile the rate of cardiovascular events was significantly higher in the high-FGF21 group than in the low-FGF21 group (P = 0.0399). In the multivariate Cox proportional hazards regression model suggested that the predictive independent risk factors for the occurrence of MACEs were FGF21 ? cut-off (HR: 1.637; 95% CI: 1.357-3.647, P = 0.029) and D-Dimer (HR: 1.420; 95% CI: 1.069-3.014, P = 0.046).ConclusionCirculating FGF21 level is elevated in the AMI patients. In AMI patients, cTnI, fibrinogen and hyperlipidemia are the inde pendent risk factors for the serum of FGF21. Higher circulating FGF21 level is associated with increased MACEs rate. This study suggests that circulating FGF21 level may be a predictive marker of the clinical outcomes in AMI patients.

Project description:ObjectiveTo determine prognostic role of endothelial progenitor cells (EPCs) in intensive care patients with acute myocardial infarction (AMI).Materials and methodsFrom December 2018 to July 2021, a total of 91 eligible patients with AMI were consecutively examined in a single intensive care unit (ICU) in China. Patients with a history of acute coronary artery disease were excluded from the study. Samples were collected within 24 hr of onset of symptoms. EPCs, defined as coexpression of CD34+/CD133+ cells or CD133+/CD34+/KDR+, were studied using flow cytometry and categorized by quartiles. Based on the 28-days mortality outcome, the patients were further divided into two groups: death and survival. The study incorporated various variables, including cardiovascular risk factors such as body mass index, hypertension, diabetes, hypercholesterolemia, atherosclerotic burden, and medication history, as well as clinical characteristics such as APACHEⅡscore, central venous-arterial carbon dioxide difference (GAP), homocysteine, creatinine, C-reactive protein, HbAlc, and cardiac index. Cox regression analysis was employed to conduct a multivariate analysis.ResultsA total of 91 patients with AMI who were admitted to the ICU were deemed eligible for inclusion in the study. Among these patients, 23 (25.3%) died from various causes during the follow-up period. The counts of EPCs were found to be significantly higher in the survival group compared to the death group (P < 0.05). In the univariate analysis, it was observed that the 28-days mortality rate was associated with the several factors, including the APACHEⅡscore (P=0.00), vasoactive inotropic score (P=0.03), GAP (P=0.00), HCY (P=0.00), creatinine (P=0.00), C-reactive protein (P=0.00), HbAlc (P=0.00), CI (P=0.01), quartiles of CD34+/CD133+ cells (P=0.00), and quartiles of CD34+/CD133+/KDR+ cells (P=0.00). CD34+/CD133+/KDR+ cells retained statistical significance in Cox regression models even after controlling for clinical variables (HR: 6.258 × 10-10 and P=0.001). Nevertheless, no significant correlation was observed between CD34+/CD133+ cells and all-cause mortality.ConclusionsThe decreased EPCs levels, especially for CD34+/CD133+/KDR+ cells subsets, were an independent risk factor for 28-days mortality in AMI patients.

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Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction.

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