IJCS | Volume 32, Nº2, March/April 2019

DOI: 10.5935/2359-4802.20180086 118 ORIGINAL ARTICLE International Journal of Cardiovascular Sciences. 2019;32(2)118-124 Mailing Address: Gustavo Lenci Marques Rua General Carneiro, 181, 12 th floor. Postal Code: 80060-900. Curitiba - PR - Brazil. E-mail: gustavolencimarques@gmail.com C-reactive Protein is a Predictor of Mortality in ST-segment Elevation Acute Myocardial Infarction Sibele Sauzem Milan o, O rlando Victorino de Moura Júnio r, A rthur Augusto Souza Bordi n, G ustavo Lenci Marque s Universidade Federal do Paraná, Curitiba, PR - Brazil Manuscript received on January 21, 2018, revised manuscript on July 02, 2018, accepted on July 23, 2018. Abstract Background: Inflammation is a major component of the response to tissue injury caused by myocardial infarction. High-sensitivity C-reactive protein (hs-CRP) levels might be a simple marker of the severity of this inflammatory response, providing prognostic information. Objective: To associate hs-CRP level on admission and other clinical characteristics with in-hospital mortality of patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: A retrospective cohort study of patients admitted with STEMI was carried out. Patients were analyzed regarding clinical characteristics, reperfusion therapy, hs-CRP on admission and outcomes. Continuous variables were analyzed by non-parametric Mann-Whitney U test and categorical variables by chi-square test. A p value of < 0.05 was considered statistically significant. Results: Of the 118 patients analyzed, 20 died during hospitalization. Higher levels of hs-CRP (p = 0.001) and older ages (p = 0.003) were observed among those patients who died. Logistic regression showed that a one unit increase in hs-CRP increased the risk of death by 15% (p = 0.0017), after adjustment for established risk factors. Similarly, each one-year increase in age increases the risk of death by 6.6% (p = 0.003). Conclusion: Our results demonstrate a strong association between hs-CRP obtained on admission and in-hospital mortality after STEMI. It suggests that hs-CRP can be a marker of inflammatory response to myocardial ischemia, providing prognostic information regarding the risk of death. (Int J Cardiovasc Sci. 2019;32(2)118-124) Keywords: Myocardial Infarction/mortality; C-Reactive Protein; Inflamation; Biomarkers; Hospital Mortality. Introduction Cardiovascular diseases are the leading cause of mortality and morbidity in the world. 1 Inflammation is thought to be the key mechanism in the pathogenesis of atherosclerosis and the value of assessing the levels of inflammatory biomarkers has risen. 2 Many prospective cohort studies have demonstrated that baseline levels of high-sensitivity C-reactive protein (hs-CRP) in apparently healthymen andwomen are highly predictive of future risk of heart attack. 3 However, inflammation is important in all phases of heart disease, including in the short-term prognosis after acute myocardial infarction (AMI). 3 In recent years, many inflammatory biomarkers have been studied to determine whether increased levels of these molecules are related to a poor prognosis in patients who have had myocardial infarction. Several studies have shown an association between C-reactive protein (CRP) and recurrent coronary events in patients with acute coronary syndrome. 3,4 CRP is a plasma protein of the pentraxin family, widely used as a general inflammatory marker, since it is an acute phase protein synthesized by hepatocytes in response to proinflammatory cytokines, particularly interleukin-6. Currently, among systemic markers of inflammation, hs-CRP has been the most studied risk predictor in the clinical practice. 1,5