hsCRP Level and the Risk of Death or Recurrent Cardiovascular Events in Patients With Myocardial Infarction: a Healthcare-Based Study
hsCRP Level and the Risk of Death or Recurrent Cardiovascular Events in Patients With Myocardial Infarction: a Healthcare-Based Study
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DOI：
10.1161/jaha.119.012638
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发表时间：
2019-06-04
影响因子：
5.4
通讯作者：
Jernberg, Tomas
中科院分区：
文献类型：
--
作者：
Carrero, Juan Jesus;Franko, Mikael Andersson;Jernberg, Tomas
背景--除了对照试验之外，关于心肌梗死（MI）患者hsCRP（高敏C反应蛋白）升高的负担、预测因子和结局的信息很少。方法和结果--我们纳入了瑞典斯德哥尔摩（2006-2011）常规医疗保健期间MI后>30天接受hsCRP检测的所有MI幸存者。排除了在住院/急诊就诊期间测量的hsCRP检测，随后使用抗生素或指示急性疾病，以及患有正在进行/近期癌症、慢性感染或免疫抑制的患者。在3个月的基线时间窗内定义炎症，并与随后的死亡和主要不良心血管事件（MI、缺血性卒中或心血管死亡的复合终点）相关。纳入了17464例患者（63%为男性;平均年龄72.6岁），中位hsCRP水平为2.2（四分位数范围，1.0-6.0）mg/L，自MI以来的中位时间为2.2（四分位数范围，0.8-4.9）年。大多数（66%）hsCRP >= 2 mg/L，40% hsCRP >3 mg/L。较低的血红蛋白、较低的估计肾小球滤过率和合并症（如心力衰竭、外周血管疾病、卒中、房颤、糖尿病和类风湿性疾病）与hsCRP >= 2 mg/L的几率较高相关。相反，既往经皮冠状动脉介入治疗、持续的肾素-血管紧张素阻滞和他汀类药物与hsCRP >= 2 mg/L的低风险相关。hsCRP >= 2 mg/L的患者发生主要不良心血管事件（n=3900;校正风险比，1.28; 95%CI，1.18-1.38）和死亡（n=4138;校正风险比，1.42; 95%CI，1.31-1.53）的风险较高。在排除前6至12个月内发生的事件后，各患者亚组的结果均稳健。在一个连续的量表上，hsCRP和预后之间的关系是线性的，直到hsCRP >5 mg/L，此后趋于平稳。除了识别高炎症风险人群外，这项研究还将这种生物标志物的预后有效性从试验证据扩展到现实世界的医疗环境。
Background-Beyond the controlled setting of trials, scarce information exists on the burden, predictors, and outcomes associated with elevated hsCRP (high-sensitivity C-reactive protein) in "real-world" patients with myocardial infarction (MI).Methods and Results-We included all-coming MI survivors undergoing hsCRP testing >30 days after an MI during routine health care in Stockholm, Sweden (2006-2011). hsCRP tests measured during hospitalization/emergency department visits, followed by antibiotics or indicative of acute illness, were excluded, together with patients with ongoing/recent cancer, chronic infections, or immunosuppression. Inflammation was defined over a 3-month baseline window and associated with subsequent death and major adverse cardiovascular events (composite of MI, ischemic stroke, or cardiovascular death). Included were 17 464 patients (63% men; mean age, 72.6 years) with a median hsCRP level of 2.2 (interquartile range, 1.0-6.0) mg/L and a median of 2.2 (interquartile range, 0.8-4.9) years since their MI. Most (66%) had hsCRP >= 2 mg/L, and 40% had hsCRP >3 mg/L. Lower hemoglobin, lower estimated glomerular filtration rate, and comorbidities (eg, heart failure, peripheral vascular disease, stroke, atrial fibrillation, diabetes mellitus, and rheumatoid diseases) were associated with higher odds of hsCRP >= 2 mg/L. Conversely, previous percutaneous coronary intervention, ongoing renin-angiotensin blockade, and statins were associated with lower hsCRP >= 2 mg/L odds. Patients with hsCRP >= 2 mg/L were at higher risk of major adverse cardiovascular events (n=3900; adjusted hazard ratio, 1.28; 95% CI, 1.18-1.38) and death (n=4138; adjusted hazard ratio, 1.42; 95% CI, 1.31-1.53). Results were robust across subgroups of patients and after exclusion of events occurring during the first 6 to 12 months. On a continuous scale, the association between hsCRP and outcomes was linear until hsCRP >5 mg/L, plateauing thereafter.Conclusions-Most patients with MI exhibit elevated hsCRP levels. Besides identifying populations at high-inflammatory risk, this study extends the prognostic validity of this biomarker from trial evidence to real-world healthcare settings.