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Observational Study
. 2019 Oct 15:293:17-24.
doi: 10.1016/j.ijcard.2019.07.022. Epub 2019 Jul 12.

Association between temporal changes in C-reactive protein levels and prognosis in patients with previous myocardial infarction - A report from the CHART-2 Study

Takuya Oikawa  1 , Yasuhiko Sakata  2 , Kotaro Nochioka  3 , Masanobu Miura  4 , Ruri Abe  1 , Shintaro Kasahara  1 , Masayuki Sato  1 , Hajime Aoyanagi  1 , Chiharu Saga  1 , Yasuko Ikeno  1 , Takashi Shiroto  1 , Koichiro Sugimura  1 , Jun Takahashi  1 , Satoshi Miyata  5 , Hiroaki Shimokawa  4 ; CHART-2 Investigators
Affiliations
Observational Study

Association between temporal changes in C-reactive protein levels and prognosis in patients with previous myocardial infarction - A report from the CHART-2 Study

Takuya Oikawa et al. Int J Cardiol. .

Abstract

Background: Several studies have reported that C-reactive protein (CRP), an inflammatory biomarker, predicts cardiovascular events independently of low-density lipoprotein cholesterol levels. However, no study examined whether temporal changes in CRP levels are associated with clinical events in patients with previous myocardial infarction (MI).

Methods and results: We examined 2184 consecutive patients with previous MI and CRP data at baseline in the Chronic Heart Failure Registry and Analysis in the Tohoku district-2 (CHART-2) Study. During the median 6.4 years follow-up, 592 all-cause, 245 cardiovascular, and 273 non-cardiovascular deaths occurred. Patients with CRP ≥ 2.0 mg/L at baseline had significantly increased incidence of all-cause (hazard ratio (HR) 1.68, P < 0.001) and non-cardiovascular death (HR 1.86, P < 0.001), compared with those with CRP < 2.0 mg/L. Temporal changes in CRP levels were associated with prognosis; among patients with CRP ≥ 2.0 mg/L at baseline, those with CRP ≥ 2.0 mg/L at 1-year had significantly increased incidence of all-cause (HR 2.12, P < 0.001), cardiovascular (HR 2.31, P < 0.001), and non-cardiovascular death (HR 2.29, P < 0.001). Among patients with CRP < 2.0 mg/L at baseline, those with CRP ≥ 2.0 mg/L at 1-year had significantly increased incidence of all-cause (HR 1.76, P < 0.001) and cardiovascular death (HR 2.10, P = 0.001). These results remained significant after adjusted with the inverse probability of treatment weighted models using propensity sore. Furthermore, as compared with patients with CRP < 2.0 mg/L at both baseline and 1-year, those with CRP ≥ 2.0 mg/L at both baseline and 1-year had increased incidence of all-cause, cardiovascular, and non-cardiovascular death.

Conclusions: These results provide the evidence that temporal increases in CRP levels are associated with increased clinical events in patients with previous MI.

Keywords: C-reactive protein; Myocardial infarction; Temporal change.

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