The relationship between high sensitivity C-reactive protein levels on admission and ST-segment resolution following successful primary percutaneous coronary intervention

OBJECTIVES
We evaluated the relationship between high sensitivity C-reactive protein (hsCRP), a marker of inflammation, measured on admission and ST-segment resolution, which is a marker of microvascular perfusion.

STUDY DESIGN
Serum hsCRP levels were measured in 113 consecutive patients (96 males, 17 females; mean age 56.9 years; range 35 to 83 years) before coronary angiography for ST-segment elevation acute myocardial infarction (MI). All the patients underwent successful (TIMI III flow) primary percutaneous coronary intervention (PCI) within 12 hours of MI. ST-segment elevation was measured on electrocardiograms obtained before PCI and after 60 minutes of TIMI III flow restoration and the difference was accepted as resolution of the sum of ST-segment elevation (∆STR). The presence and absence of no-reflow phenomenon was determined according to Schroder et al., taking ∆STR<50% (n=23, 20.4%) and ∆STR ≥50% (n=90, 79.6%), respectively.

RESULTS
On admission, patients with no-reflow phenomenon had significantly elevated peak creatine kinase (p<0.001) and hsCRP (p=0.002) levels, and significantly decreased left ventricular ejection fraction (p=0.04). A significant inverse correlation was found between ∆STR and hsCRP (r=-0.281, p=0.003). An ROC (receiver-operating characteristics) analysis showed ≥4.16 mg/l as the threshold for a high hsCRP level (n=71), which was associated with a more frequent no-reflow phenomenon (p=0.02), a higher level of peak creatine kinase (p<0.001) and a lower left ventricular ejection fraction (p=0.03). In a multivariate analysis, a high hsCRP level was found as an independent predictor for no-reflow phenomenon (odds ratio 2.1; 95% confidence interval, 1.001 to 4.4; p=0.04).

CONCLUSION
High hsCRP levels on admission may predict insufficient myocardial perfusion despite the presence of TIMI III flow following primary PCI.