Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction.
Prognostic Role of High Sensitivity C-Reactive Protein in Patients With Acute Myocardial Infarction.
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高敏 C 反应蛋白对急性心肌梗死患者的预后作用
DOI：
10.3389/fcvm.2021.659446
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发表时间：
2021
影响因子：
3.6
通讯作者：
Yu B
中科院分区：
文献类型：
--
作者：
Zhang X;Wang S;Fang S;Yu B
背景：高敏感性 CRP (hs-CRP) 引起了人们对风险评估的浓厚兴趣。我们的目的是探讨其对急性心肌梗死（AMI）患者的预后价值。方法和结果：我们在这项前瞻性队列研究中连续招募了 4,504 名 AMI 患者。通过逻辑回归分析评估 hs-CRP 水平与院内心力衰竭发生率之间的关联。通过细灰色比例子分布风险模型评估 hs-CRP 水平与住院后心力衰竭累积发生率之间的关联，将没有心力衰竭的死亡作为竞争风险。构建 Cox 比例风险回归模型来估计 hs-CRP 水平与全因死亡风险之间的关联。在中位随访 1 年期间，1,112 名患者 (24.7%) 发生院内心力衰竭，571 名患者 (18.9%) 出院后发生心力衰竭，262 名患者 (8.2%) 死亡。在完全调整的模型中，hs-CRP 值位于第 3 四分位数 (Q3) 和 Q4 的患者中，院内心力衰竭 (HF) [95% 置信区间 (CI)] 的风险分别是 Q1 患者风险的 1.36 (1.05–1.77) 和 1.41 (1.07–1.85) 倍（p 趋势 < 0.001）。与Q1患者相比，Q3和Q4具有hs-CRP值的患者出院后心力衰竭的风险分别高1.33（1.00-1.76）和1.80倍（1.37-2.36）（p趋势<0.001）。与Q1患者相比，Q3和Q4具有hs-CRP值的患者的死亡风险分别高1.74（1.08-2.82）和2.42倍（1.52-3.87）（p趋势<0.001）。结论：Hs-CRP 被发现与 AMI 患者院内心力衰竭、出院后心力衰竭和全因死亡率相关。
Background: High sensitivity CRP (hs-CRP) has attracted intense interest in risk assessment. We aimed to explore its prognostic value in patients with acute myocardial infarction (AMI). Methods and Results: We enrolled 4,504 consecutive AMI patients in this prospective cohort study. The associations between hs-CRP levels with the incidence of in-hospital HF was evaluated by logistic regression analysis. The association between hs-CRP levels and the cumulative incidence of HF after hospitalization were evaluated by Fine-Gray proportional sub-distribution hazards models, accounting for death without HF as competing risk. Cox proportional hazards regression models were constructed to estimate the association between hs-CRP levels and the risk of all-cause mortality. Over a median follow-up of 1 year, 1,112 (24.7%) patients developed in-hospital HF, 571 (18.9%) patients developed HF post-discharge and 262 (8.2%) patients died. In the fully adjusted model, the risk of in-hospital heart failure (HF) [95% confidence intervals (CI)] among those patients with hs-CRP values in quartile 3 (Q3) and Q4 were 1.36 (1.05–1.77) and 1.41 (1.07–1.85) times as high as the risk among patients in Q1 (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.33 (1.00–1.76) and 1.80 times (1.37–2.36) as high as the risk of HF post-discharge compared with patients in Q1 respectively (p trend < 0.001). Patients with hs-CRP values in Q3 and Q4 had 1.74 (1.08–2.82) and 2.42 times (1.52–3.87) as high as the risk of death compared with patients in Q1 respectively (p trend < 0.001). Conclusions: Hs-CRP was found to be associated with the incidence of in-hospital HF, HF post-discharge and all-cause mortality in patients with AMI.