C-REACTIVE PROTEIN AS A PREDICTOR OF INFARCT EXPANSION AND CARDIAC RUPTURE AFTER A FIRST Q-WAVE ACUTE-MYOCARDIAL-INFARCTION

Background Pump failure after acute myocardial infarction (AMI) can be predicted by several indices that estimate infarct size. However, the re are few indices that predict infarct expansion and cardiac rupture. We focused on the prognostic significance of serum C-reactive protein (CRP) after AMI. Methods and Results Serum CRP levels were measured e very 24 hours in 220 patients with a first Q-wave AMI. In-hospital com plications, predischarge left ventriculographic findings, and long-ter m prognosis were assessed in relation to peak CRP levels. Peak levels of both CRP and creatine kinase (CK) were higher in patients with pump failure than in those without pump failure. In patients with cardiac rupture, peak CRP levels were higher than in those without rupture (P= .001); peak CK levels were not predictive. Higher CRP levels were foun d in patients with left ventricular aneurysm (P=.001 versus those with out), aggravated heart failure (P=.03 versus those without), and cardi ac death (P<.0001 versus survivors) during the first year after AMI. M ultivariate analysis confirmed that an elevation of the peak CRP level greater than or equal to 20 mg/dL was an independent predictor of car diac rupture (relative risk, 4.72; P=.004), left ventricular aneurysma l formation (relative risk, 2.11; P=.03), and 1-year cardiac death (re lative risk, 3.44; P<.0001). Conclusions Cardiac rupture, left ventric ular aneurysmal formation, and 1-year cardiac death were associated wi th an elevation of serum CRP early after AMI, suggesting that elevatio n of CRP levels after AMI may predict infarct expansion.