Study of High Sensitive-CRP and Cardiac Marker Enzymes in Acute Coronary Syndrome .

摘要

Background: Inflammation has been proposed as a contributor to different stages in the pathogenesis of Coronary Heart Disease (CHD). High sensitive C-Reactive Protein (hs-CRP), an acute-phase plasma protein synthesized by the liver, is the most extensively studied systemic marker of inflammation. Elevated hs-CRP concentrations early in Acute Coronary Syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. The cardiac marker enzymes Creatine Kinase myocardial bound (CK-MB), Aspartate Aminotransferase (AST) and lactate dehydrogenase (LDH) have been known to be increased in coronary artery diseases. Objective: The aim of the study was to measure hs-CRP levels and other cardiac marker enzymes in ACS patients and to compare the levels of hs-CRP with other cardiac marker enzymes between ST Elevation Myocardial Infarction (STEMI) and Non-ST Elevation Myocardial Infarction (NSTEMI) patients. Material and Methods: The study group consisted of 207 consecutive patients admitted to Sri Siddhartha Medical College Hospital within the first 6 hours from the onset of chest pain. Patients were diagnosed as Unstable Angina (UA), (n=84); STEMI (n=63) and NSTEMI (n=60). ACS patients were compared with 211 healthy age and sex matched controls. Hs-CRP, CK-MB, AST and LDH levels were measured by standard methods in both groups atbaseline and for cases at 36-48 hours i.e. Peak levels. Results: ACS patients had significantly (p<0.05) higher levels of hs-CRP, CKMB, AST and LDH in comparison to controls at baseline. Hs-CRP, CK-MB, AST and LDH levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05) at baseline. There was a significant difference regarding peak hs-CRP levels between the two groups, as STEMI patients had significantly higher peak hs-CRP levels compared to NSTEMI patients (p<0.05). Conclusion: STEMI patients have significantly higher peak hs-CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, Hs-CRP assessment may assist in risk stratification after myocardial infarction.