Abstract

Background: C reactive protein (CRP) is an acute phase protein, whose concentrations increase during inflammatory states.CRP, a marker of inflammation has been shown to predict incident MI, stroke, peripheral arterial disease and sudden cardiac death. It has also been shown to predict risk of both recurrent ischemia and death among those with acute coronary syndromes. It has been found that hsCRP consistently predicts new coronary events in patients with MI and unstable angina. In acute Myocardial infarction, hsCRP consistently predicts recurrent MI independent of Troponins.

The aim of the study was to examine the baseline hsCRP values in acute myocardial infarction and to compare it with normal population, so as to study the prognostic value of hsCRP in predicting acute myocardial infarction. Also to find out the correlation between CRP levels and in hospital complications and ST segment resolution after thrombolysis with streptokinase.

Materials and methods: This was a case control study conducted in 50 patients admitted with acute ST elevation myocardial infarction within three hours of onset of index chest pain in the intensive coronary care unit under the department of medicine in a tertiary care centre in South kerala. Samples were sent for hs CRP at admission. All patients underwent thorough clinical examination and investigations. They were closely followed up for in hospital complications .ST segment resolution after thrombolysis were also assessed. 50 normal healthy age and sex matched individuals were also selected and studied.

Results: The study was conducted among 50 cases and 50 control groups. The mean hs CRP of cases were 4.35mg/L while that of control were 1.61mg/L. About 54% of the cases had hs CRP above 3 mg/L while only 32% of the control had above 3mg/L. Of the 50 cases who developed myocardial infarction 38% had anterior wall and 16% inferior wall myocadial infarction. Both inferior wall and right ventricular wall myocardial infarction was seen in 18%, while inferior wall and posterior wall myocardial infarction was seen in 18%.Rest 10% of the cases developed a combination of inferior, posterior and lateral wall myocardial infarction. Reperfusion was absent in 42% of cases who had mean hs CRP value of 4.51mg/L. Eight percent of cases who had mean hs CRP 7.8 mg/L died..The percentage of cases who developed in hospital complications of myocardial infarction like post infarction angina, cardiac failure, arrhythmias, and death were 28%,26%,34%,and 8% respectively.

Conclusions:  The hsCRP an inflammatory marker was significantly higher in cases with acute myocardial infarction. Higher levels of admission hsCRP levels were associated with increased in hospital complications including death, cardiac failure, arrhythmias and post infarction angina. Among the complications correlation of higher hsCRP levels with cardiac failure was statistically significant. Mortality after myocardial infarction was correlated with higher hs CRP levels. Higher hs CRP levels were significantly associated with lower rates of reperfusion after thrombolysis with streptokinase.

Keywords: hsCRP, myocardial infarction, streptokinase, thrombolysis, acute phase protein.