High Sensitivity CRP Predicts Long-Term Mortality in Patients with Atrial Fibrillation and Evident Acute Coronary Syndrome

Background: Atrial fibrillation (AF) is a frequent arrhythmia associated with an adverse prognostic value in patients with ACS. Risk stratification as well as diagnosis of ACS is strongly supported by biomarkers. High sensitivity CRP (hs-CRP) is known to be elevated in patients presenting with ACS as well as with AF.Methods: In total, 2034 consecutive patients with an ACS were analysed. The incidence of AF in the setting of ACS, the prognostic value of hs-CRP and the clinical outcome within 6 months were subject of the study. Death after 6 months was considered as primary endpoint. Results: The frequency of AF among patients admitted with suspected ACS was 124 (6.1%). During 6-month follow-up the mortality rate among patients with AF was significantly higher (20 [16.1%] vs 133 [6.9%]; log-rank 13.72; p 0.001) compared to patients without AF. Cox regression analysis revealed an increased risk for ACS patients with AF with an adjusted HR of 2.63 (95% CI 1.48 - 3.78; p 0.001). Patients with AF showed significant higher levels of hs-CRP than patients without AF (6.01mg/dl IQR [1.7 - 17.8] vs 3.3mg/dl IQR [1.37 - 9.83]; p = 0.003). By the use of multivariate Cox regression analysis, risk of mortality was higher when AF patients had higher concentrations of hs-CRP (HR 1.076; 95% CI 1.02 - 1.13; p = 0.002).Conclusions: AF is a strong and independent indicator for increased mortality in patients presenting with ACS. hs-CRP predicts mortality in AF patients and should be considered for risk stratification in clinical routine.

[1]  D. Brieger,et al.  Acute coronary syndrome and stable coronary artery disease: are they so different? Long-term outcomes in a contemporary PCI cohort. , 2013, International journal of cardiology.

[2]  S. Plein,et al.  Relationship of cardiac biomarkers and reversible and irreversible myocardial injury following acute myocardial infarction as determined by cardiovascular magnetic resonance. , 2013, International journal of cardiology.

[3]  K. Caidahl,et al.  Effect of new versus known versus no atrial fibrillation on 30-day and 10-year mortality in patients with acute coronary syndrome. , 2012, The American journal of cardiology.

[4]  K. Eagle,et al.  Management and outcome of acute coronary syndrome patients in relation to prior history of atrial fibrillation. , 2012, The Canadian journal of cardiology.

[5]  M. Gawaz,et al.  Macrophage Migration Inhibitory Factor Is Enhanced in Acute Coronary Syndromes and Is Associated with the Inflammatory Response , 2012, PloS one.

[6]  K. Channon,et al.  Statins as Anti-Inflammatory Agents in Atherogenesis: Molecular Mechanisms and Lessons from the Recent Clinical Trials , 2012, Current pharmaceutical design.

[7]  R. Giugliano,et al.  Can We Predict Outcomes in Atrial Fibrillation? , 2012, Clinical cardiology.

[8]  C. Hamm,et al.  Improved diagnostic and prognostic performance of a new high-sensitive troponin T assay in patients with acute coronary syndrome. , 2011, American heart journal.

[9]  E. Benjamin,et al.  Atrial fibrillation and death after myocardial infarction: risk marker or causal mediator? , 2011, Circulation.

[10]  X. Jouven,et al.  Atrial Fibrillation and Death After Myocardial Infarction: A Community Study , 2011, Circulation.

[11]  Y. Jang,et al.  Prognostic value of N-terminal probrain natriuretic peptide level on admission in patients with acute myocardial infarction and preserved left ventricular ejection fraction , 2011, Coronary artery disease.

[12]  S. Pocock,et al.  Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. , 2010, Journal of the American College of Cardiology.

[13]  E. Varol,et al.  The association between previous statin use and development of atrial fibrillation in patients presenting with acute coronary syndrome. , 2010, International journal of cardiology.

[14]  P. Sanders,et al.  Prognostic impact of types of atrial fibrillation in acute coronary syndromes. , 2009, The American journal of cardiology.

[15]  S. Hohnloser,et al.  Atrial fibrillation in acute myocardial infarction: a systematic review of the incidence, clinical features and prognostic implications. , 2009, European heart journal.

[16]  A. Peters,et al.  Determinants of the acute-phase protein C-reactive protein in myocardial infarction survivors: the role of comorbidities and environmental factors. , 2009, Clinical chemistry.

[17]  P. Cochat,et al.  Et al , 2008, Archives de pediatrie : organe officiel de la Societe francaise de pediatrie.

[18]  Ohad Parnes,et al.  Inflammation , 2008, The Lancet.

[19]  L. Newby,et al.  Short- and long-term outcomes following atrial fibrillation in patients with acute coronary syndromes with or without ST-segment elevation , 2008, Heart.

[20]  J. Herlitz,et al.  C‐reactive protein, interleukin‐6, secretory phospholipase A2 group IIA and intercellular adhesion molecule‐1 in the prediction of late outcome events after acute coronary syndromes , 2007, Journal of internal medicine.

[21]  E. Adamopoulou,et al.  The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes. , 2007, Atherosclerosis.

[22]  G. Ramani,et al.  Comparison of frequency of new-onset atrial fibrillation or flutter in patients on statins versus not on statins presenting with suspected acute coronary syndrome. , 2007, The American journal of cardiology.

[23]  J. Struck,et al.  C-Terminal Provasopressin (Copeptin) as a Novel and Prognostic Marker in Acute Myocardial Infarction: Leicester Acute Myocardial Infarction Peptide (LAMP) Study , 2007, Circulation.

[24]  Silvia G. Priori,et al.  ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association task force on practice guidelines and the European society of cardiology committee for PRAC , 2006 .

[25]  E. Watanabe,et al.  High-sensitivity C-reactive protein is predictive of successful cardioversion for atrial fibrillation and maintenance of sinus rhythm after conversion. , 2006, International journal of cardiology.

[26]  E. Maltezos,et al.  Relation of C-reactive protein to the first onset and the recurrence rate in lone atrial fibrillation. , 2006, The American journal of cardiology.

[27]  B. Gersh,et al.  Epidemiological profile of atrial fibrillation: a contemporary perspective. , 2005, Progress in cardiovascular diseases.

[28]  A. Hoes,et al.  Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. , 2005, European heart journal.

[29]  C. Heeschen,et al.  Pregnancy-associated plasma protein-A levels in patients with acute coronary syndromes: comparison with markers of systemic inflammation, platelet activation, and myocardial necrosis. , 2005, Journal of the American College of Cardiology.

[30]  K. Eagle,et al.  Comparison of outcomes of patients with acute coronary syndromes with and without atrial fibrillation. , 2003, The American journal of cardiology.

[31]  Y. Nishibori,et al.  C‐Reactive Protein and Lesion Morphology in Patients With Acute Myocardial Infarction , 2003, Circulation.

[32]  S. Marsch,et al.  Inflammation and Long-Term Mortality After Non-ST Elevation Acute Coronary Syndrome Treated With a Very Early Invasive Strategy in 1042 Consecutive Patients , 2002, Circulation.

[33]  Cynthia A. Carnes,et al.  C-Reactive Protein Elevation in Patients With Atrial Arrhythmias: Inflammatory Mechanisms and Persistence of Atrial Fibrillation , 2001, Circulation.

[34]  A. Siegbahn,et al.  Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. , 2000, The New England journal of medicine.

[35]  K A Schulman,et al.  Acute myocardial infarction complicated by atrial fibrillation in the elderly: prevalence and outcomes. , 2000, Circulation.

[36]  A. Döring,et al.  C-Reactive protein, a sensitive marker of inflammation, predicts future risk of coronary heart disease in initially healthy middle-aged men: results from the MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Augsburg Cohort Study, 1984 to 1992. , 1999, Circulation.

[37]  D. Levy,et al.  Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. , 1998, Circulation.

[38]  F. Niculescu,et al.  Inflammation, aspirin, and the risk of cardiovascular disease. , 1997, The New England journal of medicine.

[39]  P. Ridker,et al.  Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. , 1997, The New England journal of medicine.

[40]  S. Thompson,et al.  Production of C-reactive protein and risk of coronary events in stable and unstable angina , 1997, The Lancet.

[41]  A S Kosinski,et al.  Prevalence and significance of atrial fibrillation in coronary artery disease (CASS Registry). , 1988, The American journal of cardiology.

[42]  L. A. Bonet,et al.  ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012 , 2012, Turk Kardiyoloji Dernegi arsivi : Turk Kardiyoloji Derneginin yayin organidir.

[43]  B. Astor,et al.  Usefulness of high-sensitivity C-reactive protein to predict mortality in patients with atrial fibrillation (from the Atherosclerosis Risk In Communities [ARIC] Study). , 2012, The American journal of cardiology.

[44]  T. Henry,et al.  Pregnancy-associated plasma protein-A elevation in patients with acute coronary syndrome and subsequent atorvastatin therapy. , 2008, The American journal of cardiology.

[45]  Satoshi Watanabe,et al.  Relation between plasma adiponectin, high-sensitivity C-reactive protein, and coronary plaque components in patients with acute coronary syndrome. , 2008, The American journal of cardiology.