Kinetics of C-Reactive Protein Release in Different Forms of Acute Coronary Syndrome

Hospital Clínico Universitario de Valladolid, Valladolid, Castille and León, Spain
Revista Espa de Cardiologia (Impact Factor: 3.79). 05/2006; 59(5):441-7. DOI: 10.1016/S1885-5857(06)60792-5
Source: PubMed


Better knowledge of C-reactive protein (CRP) kinetics could lead to improved clinical application of this biomarker.
We studied 110 patients: 42 had ST-elevation acute myocardial infarction (STEMI), 35 had non-ST-elevation acute myocardial infarction (NSTEMI), and 33 had unstable angina. Patients were admitted to our institution within 6 hours of symptom onset. The levels of CRP, troponin-I, and creatine kinase MB fraction (CK-MB) were measured on admission and every 6 hours during the first 48 h. The CRP level was also measured daily until hospital discharge.
The median (interquartile range) CRP level increased relative to baseline from 6 hours after admission, from 5 (2-9) mg/L to 6 (3-10) mg/L (P=.004). Although, CRP levels on admission were similar in all groups, there was a significant difference in peak CRP level: it was 67 (36-112) mg/L in the STEMI group, 29 (20-87) mg/L in the NSTEMI group, and 18 (12-36) mg/L in the unstable angina group. The maximum CRP level was observed 49 (38-53) hours after the onset of symptoms, but occurred later in patients with STEMI. Although there was only a weak non-significant correlation between CRP and troponin levels (r=0.135) at admission, the maximum CRP level was found to be influenced by the degree of myocardial damage (r=0.496; P< .001).
The pattern of CRP release observed was clearly different in different forms of acute coronary syndrome. Although the CRP level measured at admission was similar in all patient groups, it was influenced by the degree of early myocardial tissue necrosis. This variation in CRP kinetics should be taken into consideration when designing future studies.

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    • "Conflicting clinical data exist with respect to its prognostic value, probably a reflection of the different times when samples were taken and the wide variation in the resuls obtained [115] [116]. Sánchez et al, have demonstrated a variation in C-reactive protein kinetics in ACS-patients [117]. In the same way, our group has shown circadian changes in the values of C-reactive protein in patients with ACS, which should also be evaluated when determining the number and the hours since extraction of the blood samples [118]. "
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    ABSTRACT: Clinicians have used additional tools to aid clinical assessment and to enhance their ability to identify the "vulnerable" patient at risk for cardiovascular diseases. Circulating biomarkers are one such tool used for identifying better high-risk individuals and to prognosticate effectively and treat patients with disease. A persistent immune activation is a main feature of atherosclerosis. The inflammatory activity is not only detectable in the vascular wall, but also in peripheral blood. Patients with coronary artery disease show increased numbers of neutrophils and T cells as well as elevated levels of several inflammatory mediators. On the other hand, several cardiovascular disease states show a daily cycle of activity, i.e. a peak incidence of cerebrovascular and cardiovascular events has been documented in the early morning hours. Several studies have shown diurnal variations in inflammatory systemic markers in patients with acute coronary syndrome. Diurnal variations can alter the analysis of blood-derived samples. Prior to the analysis of a blood sample, multiple steps are necessary to generate the desired specimen. The knowledge of diurnal variations is a prerequisite to understand and control their impact. This brief review comments the effect of the diurnal variation on the most important inflammatory systemic biomarkers in the setting acute coronary syndrome: interleukin-6, neopterin, matrix metalloproteinases, vascular cell adhesion molecule-1, intercellular adhesión molecule-1, soluble CD40 ligand, and C-reactive protein.
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