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Int J Cardiol. 2019 Jul 15;287:13-18. doi: 10.1016/j.ijcard.2019.03.049. Epub 2019 Mar 27.

Inflammation during acute coronary syndromes - Risk of cardiovascular events and bleeding.

Author information

1
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland. Electronic address: david.nanchen@chuv.ch.
2
Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
3
Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland.
4
Department of Cardiology, University Hospital Bern, Bern, Switzerland.
5
Institute of Clinical Chemistry, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
6
Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
7
Royal Brompton & Harefield Hospital Trust and Imperial College, London SW3 6NP, UK.
8
Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland.

Abstract

BACKGROUND:

Many parameters can affect the level of inflammation during acute coronary syndromes (ACS). We aimed to assess the one-year risk of major adverse cardiovascular events (MACE) and bleeding associated with elevated hsCRP levels during ACS, taking into account the severity of myocardial infarction, the timing of blood sampling and established long-term prognostic factors.

METHODS:

We studied 1864 consecutive patients with ACS enrolled in a contemporary multicenter prospective cohort study in Switzerland. HsCRP levels were determined at hospital admission. One year after discharge MACE and bleeding events were assessed. Multivariable adjusted Cox proportional hazards were computed with age, sex, time from symptom onset to blood draw, body mass index, current smoking, hypertension, diabetes mellitus, pre-existing cardiovascular disease, history of inflammatory disease, LDL-cholesterol levels, type of ACS, left ventricular ejection fraction and GRACE 1.0 risk score.

RESULTS:

At one-year follow-up, 151 (8.1%) patients suffered MACE. Compared to patients with hsCRP below 2 mg/l, the risk of MACE was higher in patients with hsCRP levels between 2 and 5 mg/l, with a multivariate adjusted hazard ratio (HR) of 1.63 (95% confidence interval (CI) 0.93-2.84), in those with levels between 5 and 10 mg/l, with a HR of 2.80 (95% CI 1.58-4.96), and in those with levels above 10 mg/l, with a HR of 2.23 (95% CI 1.28-3.88). There was no difference in bleeding risk between the four groups.

CONCLUSIONS:

Systemic inflammation in the acute phase of myocardial infarction is an independent predictor for cardiovascular events, but not for bleeding.

KEYWORDS:

Acute coronary syndromes; HsCRP; Inflammation; Prevention; Prognosis

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