Role and Prognostic Significance of Inflammation in Acute Myocardial Ischemia

Chronic inflammation plays an important role in the pathophysiology of atherosclerosis. It is suggested that some triggering factors exacerbate chronic inflammation process in stable atherosclerotic plaque and might lead to acute ischemic syndromes. In order to investigate the role of acute inflammation in acute ischemic syndromes, we conducted a study comprising 78 patients with stable angina pectoris (34 patients), unstable angina pectoris (27 patients) and acute myocardial infarction (17 patients). The C-reactive protein (CRP) and fibrinogen levels which are sensitive markers of acute inflammation were measured in all patients and compared prospectively during the acute and convalscence phases. CK-MB values measured at admission were normal in all of the patients included in the study. Mean CRP concentrations in patients with unstable angina pectoris measured at hospital admission and one month later of hospital discharge were 1,34± 1,34 mg/dl and 0,75±0,65 mg/dl, respectively (p=0,024). The elevated initial CRP value decreased significantly during the Iate convalescence phase. The mean CRP and fibrinogen values in patients with and without major coronary events were not significantly different from each other. These was not any significant difference between the initial and last mean CRP values in patients with and without major coronary events were not significantly different from each other. There was not any significant difference between the initial and last mean CRP values in patients with acute myocardial infraction. However, the initial and last mean fibrinogen concentrations were 269± 112 mg/dl and 439± 116 mg/dl respectively (p=O,OOO). The fibrinogen level increased significantly and gradually during the convalescence phase. In predicting the major and minor coronary events, fibrinogen showed high specificity and positive predictive value. The initial mean CRP values in group 1,2 and 3 were 0,59±0,19 mg/dl, 1,34±1,34 mg/dl and 0,9±1,33 mg/dl, respectively (p=0,014). The mean CRP value in group 2 was significantly different from group l. The correlation of the initial mean CRP and fibrinogen concentrations measured in all patient was weak (r=0,31; p=0,006). According to our results, we suggest that acute inflammation might play an active role in triggering unstable angina pectoris. In addition, both CRP and fibrinogen are not useful prognostic guides in acute ischemic syndromes.