A study on Role of circulating hsCRP as a biomarker of clinical significance in acute MI and Identification of extent of involvement, risk assessment and post MI complications.

N.Hemalatha; Narasinga Rao Siddanathi; K.Indira Devi; B.V.Chandrakala; G.V.Hari Krishna

Volume : VI, Issue : V, May - 2016

A study on Role of circulating hsCRP as a biomarker of clinical significance in acute MI and Identification of extent of involvement, risk assessment and post MI complications.

N. Hemalatha, Narasinga Rao Siddanathi, K. Indira Devi, B. V. Chandrakala, G. V. Hari Krishna

Abstract :

 Introduction: Myocardial infarction (MI) due to coronary artery disease (CAD) has become a leading cause of death worldwide surpassing malnutrition and infectious diseases especially in a developing country like India. However, recent technological advances in diagnostic tools have led to the utilization of various blood biomarkers of clinical significance in detecting heart disease like myocardial infarction at an early stage. Various lipid, protein and enzymatic biomarkers like lipoproteins, CK–MB, troponin and inflammatory acute phase proteins have been studied extensively for the early detection and management. There is a need for studies involving a single biomarker of detection as well as for identification of the extension of involvement to decide on effective management of patient. Hence we have focused on the study of variations in serum high sensitive C reactive protein (hsCRP) concentration and its correlation with the extent of lesion involvement in MI. Some clinical studies have shown circulating levels of CRP correlating with total infarct size in acute MI, post MI complications and with prognosis. Thus CRP is beginning to emerge as a marker of underlying coronary inflammation indicating the extent of myocardial necrosis. Keeping in view the significance of this aspect of role of hsCRP estimation, we studied 50 cases presenting with acute coronary syndrome (ACS) to King George Hospital, Visakhapatnam, India from December 2012 to September 2014. We measured hsCRP level in each patient to determine the association between hsCRP and ACS and its significance in the prognosis. Results: Acute Coronary syndrome was observed to be highest among the age group of 41 to 50 years and chest pain was the most common presenting complaint with smoking as the most common risk factor. Out of 50 patients with acute coronary syndromes, 34(68%) patients had STEMI, 8 (16%) had UA and 8 (16%) had NSTEMI. Out of 34 patients who had STEMI, extensive anterior wall involvement was the most common type. Left ventricular failure was the most common complication seen in 15(30%) patients. Serum hsCRP levels were significantly increased in 34 (68%) out of 50 patients of acute coronary syndrome and 30 (60%) patients with high hsCRP levels developed post MI complications with LVF being the most common. All the values showed statistical significance was (P<0.01). Conclusion: Present study has shown a strong correlation not only in the various levels of serum hsCRP and ACS, but has also shown an association between the concentration of the hsCRP and the extent of myocardial involvement and post MI complications. The observed strong association establishes the role of inflammatory markers in atherosclerosis and progress to acute myocardial infarction and post MI complications. Hence hsCRP being an acute phase protein, a strong inflammatory marker with a longer half–life can be considered as a robust biomarker of clinical significance. The fact that more number of STEMI patients having increased levels of hs–CRP shows increased incidence of adverse cardiac outcomes, when compared with UA/NSTEMI, suggest that hs–CRP levels may be related to the severity of inflammatory processes associated with multiple plaque rupture or infarct expansion in the spectrum of acute coronary syndrome. Raised hs–CRP levels are independent markers of adverse outcomes. Hence hs–CRP levels obtained at admission in acute coronary syndromes can be used as a marker for identification of patients who are likely to develop significant complications in the immediate in–hospital course and to predict the prognosis. However, the limitation of this study includes a small sample size and a single serum hsCRP measurement instead of serial estimations at intervals and this limitation can be overcome in our future studies.