Study of hs-CRP in acute coronary syndrome in non-diabetic patients

Abstract EN

Background: The clinical implications of hsCRP in coronary heart disease are attracting considerable attention.

Several studies demonstrated that higher hsCRP level are associated with inflammation of coronary vessels, so it is reasonable to suggest that high hsCRP are associated with adverse outcome as a result of coronary instability .

Several studies agreed that hsCRP could be used to predict in hospital and long-term outcome in patients with AMI and the vulnerability of acute lesions in acute myocardial infarction (AMI).

There were also reports that risk of cardiac rupture and death seemed to be increased in patients with highly elevated CRP levels.

These findings apply to CRP concentrations within several hours to days after the onset of AMI. Objectives : to study the hs-CRP in different conditions of acute coronary syndrome and to assess its value in early diagnosis of Acute coronary syndrome and the association between hs-CRP and insulin resistance as cardiovascular risk. Subjects and Methods: This study was conducted on 60 subjects excluding those with history of diabetes mellitus, history of previous ischemic heart disease, those recieving drugs (Statins, Non steroidal anti-inflammatory, Steroids or any drugs that may affect the inflammatory process) and any patient with acute illness that may raise the C-reactive protein.; The enrolled subjects were divided into two groups: Group A: included 40 patients who were presented with acute coronary syndrome.

They were further subdivided into Group A-1: 13 patients, 8 males, 5 females presented with unstable angina .Group A-2: 27 patients, 22 males and 5 females presented with Acute Myocardial Infarction. Group B: 20 healthy subjects 11 males and 9 females were taken as the control group.

All subjects will be subjected to Full clinical history, thorough clinical examination, complete blood picture, fasting Blood Glucose & oral glucose tolerance test, kidney function, liver function ,lipid profile ,fasting Plasma Insulin ,the homeostatic model assessment–insulin resistance (HOMA-IR), cardiac Enzymes ,highly sensitive C-reactive protein, electrocardiography and echocardiography. Results: Our study revealed that hsCRP was higher in patients with acute myocardial infarction than in patients with unstable angina, and both values were significantly higher than levels in the control group with P value < 0.001 suggesting the role of hsCRP in the inflammation.

Also it revealed a positive significant statistical correlation between hsCRP and smoking, hypertension, total cholesterol and LDL cholesterol with P value <0.05.

Whereas the correlation between hsCRP and triglycerides or HDL cholesterol was non significant with P value >0.05.Our study also revealed a positive significant correlation between hsCRP and CPK & CK-MB in patients with unstable angina with P value <0.05and a positive highly significant correlation between hsCRP and CPK, CK-MB& troponin in patients with acute myocardial infarction with P value <0.001.

According to the OGTT we found among the 40 patients; (8) Non-diabetic patients, (12) Impaired glucose tolerance, and (20) Diabetic patients with a positive significant correlation between hsCRP and blood glucose with P value <0.05.

It revealed also a positive significant statistical correlation between hsCRP and Fasting insulin & HOMA-IR as a detector of insulin resistance as well as significant statistical correlation with segmental wall motion abnormality with P value <0.05 , whereas a negative significant statistical correlation between hsCRP and ejection fraction with P value <0.05.

Conclusion: We concluded that serum level of hsCRP measured once on admission in patients with Acute Myocardial infarction can be used to diagnose ACS, as well as it can predict the morbidity and mortality as increased hsCRP levels are associated with lower Ejection fraction and higher Wall motion Score Index and hence a worse post myocardial infarction out