PROGNOSTIC IMPACT OF ADMISSION RAISED C-REACTIVE PROTEIN IN ACUTE MYOCARDIAL INFARCTION PATIENTS

Abstract

Background: Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide, often resulting from an inflammatory cascade that contributes to coronary artery plaque instability and thrombosis. C-reactive protein (CRP), an acute-phase reactant, has gained prominence as a potential biomarker for predicting adverse cardiac outcomes. Elevated CRP at admission may offer prognostic insight into myocardial injury severity and risk of complications during hospitalization.

Objective: To assess the prognostic significance of elevated admission CRP levels in patients presenting with acute myocardial infarction.

Methods: This prospective observational study was conducted at the Cardiology Department of Combined Military Hospital, Multan, over 18 months from September 2023 to February 2025. A total of 80 AMI patients aged 18 years or older were enrolled. Admission CRP levels were measured using an immunoturbidimetric assay, and patients were stratified into two equal groups based on a CRP cut-off value of ≥6 mg/dL. All patients were evaluated for in-hospital outcomes including major adverse cardiovascular events (MACE)—defined as cardiogenic shock, ventricular arrhythmias, or acute heart failure—and mortality. Left ventricular ejection fraction (LVEF) and troponin-I levels were also recorded. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of CRP for MACE.

Results: The mean age of patients was 57.65 ± 9.48 years, with diabetes being the most common comorbidity (56.3%). The median CRP and troponin-I levels on admission were 5.90 (IQR: 4.90) mg/dL and 1.02 (IQR: 1.14) ng/mL, respectively. Elevated CRP levels were associated with significantly reduced LVEF and increased troponin-I concentrations. Patients with CRP ≥6 mg/dL showed a significantly higher incidence of MACE, with an odds ratio of 1.428 (95% CI: 1.17–1.74, p < 0.001). ROC analysis revealed an AUC of 0.738, with a CRP cut-off of 6.2 mg/dL yielding 65% sensitivity and 80% specificity for predicting MACE.

Conclusion: Elevated CRP levels at admission serve as a sensitive, though non-specific, marker of myocardial injury severity and are strongly associated with adverse cardiovascular outcomes in AMI patients.