Fibrinogen and C-reactive protein on admission as markers of final infarctsize after primary angioplasty for acute myocardial infarction

Background: In acute myocardial infarction (AMI) treated conservatively or with thrombolysis, marked increases of C-reactive protein (CRP) and fibrino gen have been observed. No data are however available concerning a possible relation between CRP and fibrinogen levels on admission and markers of inf arct size after obtaining thrombolysis in myocardial infarction (TIMI) flow III by primary angioplasty. Methods: We studied 34 patients with a first A MI (29 men, mean age 54 +/- 11 years) who were treated with primary angiopl asty (TIMI flow III in all patients, no concomitant treatment with glycopro tein IIb-IIIa antagonists) within 6 h of onset of pain. CRP and fibrinogen levels on admission were determined and related to the following markers of infarct size: peak creatine kinase MB (CKMB) levels, radionuclide left ven tricular ejection fraction (LVEF) at discharge and thallium-201 single-phot on emission computed tomography (SPECT) infarct size at 1 month. Results: M edian CRP levels were 0.4 mg/dl (range 0.09-3 mg/dl), median fibrinogen lev els 412 mg/dl (range 198-679 mg/dl), mean CKMB was 178 +/- 151 U/l, mean LV EF 52 +/- 8% and mean thallium-201 infarct size 7 +/- 6%. Although CRP leve ls were related to fibrinogen levels on admission (r=0.56, P = 0.002), only fibrinogen levels were related to markers of infarct size (r = 0.58, P = 0 .001 for CKMB, r = - 0.44, P = 0.01 for LVEF and r=0.64, P=0.001 for thalli um-201 infarct size). No relation was found between CRP or fibrinogen level s on admission and the extent of coronary artery disease or the myocardial area at risk. In multiple regression analysis, the relation between fibrino gen and markers of infarct size was independent of CRP levels and the durat ion of pain on admission. Conclusions: These findings indicate a relation b etween fibrinogen levels on admission and myocardial infarct size in patien ts treated with primary angioplasty for AMI. This relation seems to be inde pendent of CRP levels and the duration of pain on admission. If confirmed i n larger patient populations, fibrinogen levels on admission could have an important value for risk stratification and more aggressive reduction of in farct size in patients who are treated with primary angioplasty. (C) 2001 E lsevier Science Ireland Ltd. All rights reserved.