Concentrations of C-Reactive Protein and B-Type Natriuretic Peptide 30 Days after Acute Coronary Syndromes Independently Predict Hospitalization for Heart Failure and Cardiovascular Death: Just Another Brick in the Wall?

摘要

In this issue of Clinical Chemistry , Scirica and colleagues have examined the role of C reactive protein (CRP)1 as a risk predictor of heart failure and cardiac death after admission with suspected acute coronary syndromes (1). They highlight the important fact that heart failure after acute myocardial infarction (AMI) is a significant predictor of an adverse prognosis. Indeed, the success of cardiologists in myocardial salvage post-AMI is producing a cohort of patients who have survived but with a damaged myocardium and who will, inexorably, progress to heart failure. Heart failure is a growing cause of morbidity, mortality, and cost in health care systems throughout the world. The study was performed within the context of an interventional trial. It is therefore worth examining how it fits into the body of knowledge about CRP and heart failure and if it supports the notion that it is now prime time for high-sensitivity CRP (hsCRP) measurement.The pentraxins are a superfamily of conserved proteins characterized by a cyclic multimeric structure. The classical short pentraxins are CRP and serum amyloid P component, acute-phase proteins. Long pentraxins have an unrelated, long amino-terminal domain coupled to the carboxy-terminal pentraxin domain. CRP was originally isolated as a protein that binds to the C-polysaccharide of the cell wall of pneumococci. It is a pentraxin composed of 5 23-kDa subunits that plays a key role in the innate immune response and is produced mainly by hepatocytes after stimulation by cytokines, of which interleukin-6 (IL-6) appears the major inducer. hsCRP concentrations increase 6 h after acute stimuli, reaching a peak (up to 100-fold above baseline) within 48 h. With abrupt cessation of stimuli, values decrease exponentially at a rate close to the half-life of …