Archives of the Turkish Society of Cardiology
The relationship between high sensitivity C-reactive protein levels on admission and ST-segment resolution following successful primary percutaneous coronary intervention [Turk Kardiyol Dern Ars]
Turk Kardiyol Dern Ars. 2006; 34(7): 406-412

The relationship between high sensitivity C-reactive protein levels on admission and ST-segment resolution following successful primary percutaneous coronary intervention

Hüseyin Uyarel, Hülya Kaşıkçıoğlu, Zeynep Tartan, Özgür Akgül, Dilek Şimşek, Mustafa Çetin, Emrah Bozbeyoğlu, Ali Buturak, Bülent Uzunlar, Ertan Ökmen, Neşe Çam
Dr Siyami Ersek Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Cardiology Department, Istanbul, Turkey


OBJECTIVES
We evaluated the relationship between high sensitivity C-reactive protein (hsCRP), a marker of inflammation, measured on admission and ST-segment resolution, which is a marker of microvascular perfusion.

STUDY DESIGN
Serum hsCRP levels were measured in 113 consecutive patients (96 males, 17 females; mean age 56.9 years; range 35 to 83 years) before coronary angiography for ST-segment elevation acute myocardial infarction (MI). All the patients underwent successful (TIMI III flow) primary percutaneous coronary intervention (PCI) within 12 hours of MI. ST-segment elevation was measured on electrocardiograms obtained before PCI and after 60 minutes of TIMI III flow restoration and the difference was accepted as resolution of the sum of ST-segment elevation (∆STR). The presence and absence of no-reflow phenomenon was determined according to Schroder et al., taking ∆STR<50% (n=23, 20.4%) and ∆STR ≥50% (n=90, 79.6%), respectively.

RESULTS
On admission, patients with no-reflow phenomenon had significantly elevated peak creatine kinase (p<0.001) and hsCRP (p=0.002) levels, and significantly decreased left ventricular ejection fraction (p=0.04). A significant inverse correlation was found between ∆STR and hsCRP (r=-0.281, p=0.003). An ROC (receiver-operating characteristics) analysis showed ≥4.16 mg/l as the threshold for a high hsCRP level (n=71), which was associated with a more frequent no-reflow phenomenon (p=0.02), a higher level of peak creatine kinase (p<0.001) and a lower left ventricular ejection fraction (p=0.03). In a multivariate analysis, a high hsCRP level was found as an independent predictor for no-reflow phenomenon (odds ratio 2.1; 95% confidence interval, 1.001 to 4.4; p=0.04).

CONCLUSION
High hsCRP levels on admission may predict insufficient myocardial perfusion despite the presence of TIMI III flow following primary PCI.

Keywords: Biological markers, C-reactive protein, coronary disease, electrocardiography; myocardial infarction; myocardial reperfusion

How to cite this article
Hüseyin Uyarel, Hülya Kaşıkçıoğlu, Zeynep Tartan, Özgür Akgül, Dilek Şimşek, Mustafa Çetin, Emrah Bozbeyoğlu, Ali Buturak, Bülent Uzunlar, Ertan Ökmen, Neşe Çam. The relationship between high sensitivity C-reactive protein levels on admission and ST-segment resolution following successful primary percutaneous coronary intervention. Turk Kardiyol Dern Ars. 2006; 34(7): 406-412

Corresponding Author: Hüseyin Uyarel, Türkiye
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