The association between C-reactive protein on admission and mortality in patients with acute myocardial infarction
The association between C-reactive protein on admission and mortality in patients with acute myocardial infarction
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DOI：
10.1046/j.1365-2796.2000.00670.x
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发表时间：
2000-03-01
影响因子：
11.1
通讯作者：
Huber, K
中科院分区：
文献类型：
--
作者：
Nikfardjam, M;Müllner, M;Huber, K
目标。在急性心肌梗死患者中，血清c反应蛋白的病理生理学和预后价值尚未明确。本研究评估了急性心肌梗死患者入院时血清c反应蛋白水平与死亡率之间的关系。回顾性队列研究。背景。三级保健中心。病人。3年内共收治急性心肌梗死患者729例。主要结果测量。入院时c反应蛋白水平、心血管危险因素及观察期内的生存率。在3年的观察期内，118名患者死于心血管疾病。随着血清c反应蛋白水平（< 0.5、0.5 ~ < 2、2 ~ < 5、5 ~ 10 mg dL(-1)）的增加，死亡率也增加（分别为14%、19%、20%、39%和28%）。在多变量Cox回归模型中，在控制年龄、溶栓治疗、疼痛发作至入院时间间隔、吸烟、糖尿病、高胆固醇血症、高血压、入院时肌酸激酶升高等混杂效应后，血清c反应蛋白升高与死亡风险之间只有微弱且不显著的关联。因急性心肌梗死而入院的血清c反应蛋白浓度升高的患者死亡风险增加。然而，这种关联在很大程度上是由其他基线变量，特别是心肌缺血持续时间的估计来解释的。超灵敏检测c反应蛋白是否更适合于未选择的急性心肌梗死患者的风险分层，还需进一步研究。
Objective. In patients presenting with acute myocardial infarction the pathophysiologic and prognostic value of serum C-reactive protein is not well defined. This study assessed the association between serum C-reactive protein levels on admission and mortality in patients admitted because of acute myocardial infarction.Design. Retrospective cohort study.Setting. Tertiary care centre.Patients. A total of 729 patients with acute myocardial infarction admitted within a period of 3 years.Main outcome measures. C-reactive protein levels on admission, cardiovascular risk factors and survival within the observational period.Results. Within the 3-year observational period, 118 patients died of a cardiovascular cause. With increasing serum C-reactive protein levels (< 0.5, 0.5 to < 2, 2 to < 5, 5-10 and > 10 mg dL(-1)) mortality also increased (14%, 19%, 20%, 39% and 28%, respectively). When controlling for the confounding effect of age, thrombolytic treatment, the time interval between onset of pain and admission, smoking, diabetes mellitus, hypercholesterolemia, hypertension, and elevated creatine kinase on admission in a multivariate Cox regression model, there was only a weak and nonsignificant association between increased serum C-reactive protein and the risk of death.Conclusions. Patients with elevated concentrations of serum C-reactive protein admitted to the hospital because of acute myocardial infarction are at an increased risk of dying. This association is however, largely explained by other baseline variables, in particular by an estimate of the duration of myocardial ischaemia. If C-reactive protein measured by means of an ultra-sensitive assay is more suitable for risk stratification of unselected patients with acute myocardial infarction, needs further study.