Value of High Sensitive CRP in Hyperglycemic Patients with Acute Coronary Syndrome | ||
| Sohag Medical Journal | ||
| Article 42, Volume 22, Issue 1, January 2018, Pages 273-280 PDF (102.14 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/smj.2018.41790 | ||
| Authors | ||
| Alaa Ez El-Deen Said1; Omar Saad Mohammed2; Yasser Mohamed Kamal3; Adel Abdel Aziz El Sayed4 | ||
| 1Department of Internal Medicine, Sohag university Hospital. | ||
| 2Department Internal Medicine, Sohag university Hospital. | ||
| 3Department of Internal medicine , Faculty of Medicine, Sohag University. | ||
| 4Department Internal Medicine , Sohag university Hospital. | ||
| Abstract | ||
| BACKGROUND: Hyperglycemia on admission in patients with acute coronary syndromes is common, and it is a powerful predicator of increased risk of in hospital complications in patients with and without diabetes mellitus, high sensitivity c- reactive protein (hs- CRP) is a cardiovascular risk marker in patients with acute coronary syndrome. OBJECTIVES: 1. To determine the levels of high-sensitivity C-reactive protein (hs-CRP) in subjects of acute coronary syndrome with admission hyperglycemia whatever diabetic or not. 2. To determine the levels of high-sensitivity C-reactive protein (hs-CRP) in subjects of acute coronary syndrome without admission hyperglycemia. 3. To compare the results of the above two groups and assess the prognostic value of admission glucose and hs -CRP levels in hyperglycemic patients with acute coronary syndromes. DESIGN AND SETTING: Prospective study, at Sohag university hospital in Egypt. METHODS: We measured the blood glucose, hs -CRP, cardiac enzymes and HBAIC levels at admission in 100 consecutive patients with ACS. Glucose was categorized as ≤11.1mmol=200 mg/dl. hs -CRP negative 3 mg, HBAIC ≤ 6.5% or ≥ 6.5). RESULTS: In our study reveals a statistically significant relation between levels of admission glucose and left ventricular function (LV failure, pulmonary edema and cardiogenic shock) or arrhythmias in hyperglycemic patients with ACS (P< 0.0001). Also there is a significant relation between level of hs- CRP and LVF and type of myocardial infarction in-hospital complications. Also there is insignificant relation between HBAIC levels and left ventricular function in ACS at admission. CONCLUSION: We conclude that elevated admission glucose appears a more important in predicting in-hospital and short term complications particularly left ventricular failure and cardiogenic shock in patients with acute coronary syndromes. Also the increased levels of hs- CRP are a predictor for severity and extent of myocardial damage and left ventricular function especially in STEMI. The synergistic effect of associated both stress hyperglycaemia and hs- CRP is a strong predictor for poor ACS outcome. | ||
| Keywords | ||
| High-sensitivity C-reactive protein level; hyperglycemia; Inflammatory marker; Atherosclerosis; Acute Coronary Syndrome | ||
|
Supplementary Files
|
||
| References | ||
|
1. Ridker PM, Rifai N, Rose L, Buring JE, Cook NR. Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardiovascular events. N Engl J Med. 2002;347(20):1557-65.
2. Clearfield MB. C-reactive protein: a new risk assessment tool for cardiovascular disease. J Am Osteopath Assoc. 2005;105(9):409-16 .
3. Pfützner A, Forst T. High-sensitivity C-reactive protein as cardio vascular risk marker in patients with diabetes mellitus. Diabetes Technol Ther. 2006;8(1):28- 36.
4. Ritchie SA, Connell JM. The link between abdominal obesity, metabolic syndrome and cardiovascular disease. Nutr MetabCardiovasc Dis.2007;17(4):319-26.
5. Rasoul S,Ottevanger JP, Bilo HJ, Timmer JR,Van’t Hof Aw,ambrink JH,Dikkeschei LD, Hoorntje Jc, de Boer MJ and Zijistra F. Neth J Med.2007 Mar; 65 (3): 95-100.
6. Foo K, S Cooper,C Knight , A Suliman, K Ranjadayalan and A DTimmis. Single Serum glucose measurement predicts adverse outcomes across the whole range of acute coronary syndromes. Heart 2003; May; 89(5):512-516.
7. Hadjads S, Coisne D, Mavco G, Ragot S, Duengler F, Sosner P, Torremocha F,Herpin D andMarechaudR.Prognostic value of admission plasma glucose and HbA inacute myocardial infarction. Diabetes Med.2004; 21:305-310.
8. Isihara M, Inoue I, Kawagoe T, Shimatani Y. Kurisu S, Nishioka K. Umemura T, Nikamura S, andYoshida M.Impact of acute hyperglycemia on left ventricular function after reperfusion therapy in patients with first anterior myocardial infarction. Am Heart J. 2003; 164:674-678.
9. Rasoul S,Ottevanger JP, Bilo HJ, Timmer JR,Van’t Hof Aw, Dambrink JH, DikkescheiLD, Hoorntje Jc, de Boer MJ and Zijistra F.Glucose Dysregulation in non diabetic patients with St-elevation myocardial Infarction : Acute and chronic glucose dysregulation in STEMI. Neth J Med.2007 Mar; 65 (3): 95-100.
10.Timmer, JP, Ottervanger, H.S.G, Bilo, J.H.E Dambrink, K, Miedema, J.C.A and Zigilstra F.Prognositc value of admission glucose and glycosylated haemoglobin levels inacute coronary syndromes. J Med 2006;99:237-243.
11. Malmberg K, Rydn L, Wadel H, Birkeland K, Bootsma A, Dickstink, Efendic S, Fisher M, Hamsten A.Herlitz J, Hildebrandt P, Macleod K, Laakso M, Torppederson C, and Valdenstrom A; DIEAMI Z Investigators. Intense Metabolic Control by means an insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI Z): Effects on mortality and morbidity. Eur Heart J 2005; 26:650-61.
12.Kausik K, Christopher P, Canon, David A., Buros J, Rifai N, Carolyn H, Mc Cabe, C. Gibson M andBraunwald E. Synergestic relationship between hyperglycemia and inflammation with respect to clinical outcomes in Non-ST elevation acute coronary syndromes; Analysis from OPUS – TIMI 16 and TACTICS – TIMI 18. European Heart Journal 2007 28(7):806-813.
13.Timmer JR, Bilo HJG, Ottervanger JP, Dambrink JHE, Miedema K, Hoorntje JCA, Zijlstra F.Dysglycemia in suspected acute coronary syndromes. Eur J Intern Med2005; 16:29 9. Tenerz A, Nilsson G, Forberg R, Ohrvik J, Malmberg K, Berne C, Leppert J. Basal glucometabolic status has an impact on long-term prognosis following an acute myocardial infarction in non-diabetic patients. J Intern Med 2003; 254:494–503.
14.Gresele P, Guglielmini G, De Angelis M, Ciferri S, Ciofetta M, Falcinelli E, Lalli C, Ciabattoni G, Davi G, Bolli GB.Acute, short-term hyperglycemia enhances shear stress-induced platelet activation in patients with type II diabetes mellitus. J Am Coll Cardiol 2003; 41:1013–20.
15.Lind L, Fugmann A, Branth S, Vessby B, Millgard J, Berne C, Lithell H.The impairment in endothelial function induced by non-esterified fatty acids can be reversed by insulin. Clin Sci (Lond) 2000; 99:169–74.
16.Marfella R, Siniscalchi M, Esposito K, Sellitto A, De Fanis U, Romano C,Portoghese M, Siciliano S, Nappo F, Sasso FC, Mininni N, Cacciapuoti F, Lucivero G, Giunta R, Verza M, Giugliano D. Effects of stress hyperglycemia on acute myocardialinfarction: role of inflammatory immune process infunctional cardiac outcome. Diabetes Care 2003; 26:3129–35.
17.Esposito K, Nappo F, Marfella R, Giugliano G, Giugliano F, Ciotola M, Quagliaro L, Ceriello A, Giugliano D. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002; 106:2067–72
(18. Duarte ER, Pellanda LC, Portal VL. Perfil inflamatório, metabólico e lipídico na síndrome isquêmica aguda: relação com eventos intra e pós-hospitalares. Arq Bras Cardiol. 2005;84(2):122-9.
(19. Zebrack JS, Anderson JL, Maycock CA, Horne BD, Bair TL, Muhlestein JB. Usefulness of high–sensitivity C reactive protein in predicting long term risk of death or acute myocardial infarction in patients with unstable or stable angina pectoris or acute myocardial infarction. Am J Cardiol 2002;89:145 :9.
(20.Cusack MR, Marber MS, Lambiase PD, Bucknall CA, Redwood SR. Systemic inflammation in unstable angina is the result of myocardial necrosis. J Am Coll Cardiol 2002;39:1917-23.
(21.Rubins HB, Robins SJ, Collins D, Fye CL, Anderson JW, Elam MB, et al. Gemfibrozil for the secondary prevention of coronary heartdisease in men with low levels of high-density lipoprotein cholesterol. Veterans Affairs high-density lipoprotein cholesterol intervention trial study group. N Engl J Med 1999;341:410-8.
(22.Perski A, Olsson G, Landou C, de Faire U, Theorell T, Hamsten A. Minimum heart rate and coronary atherosclerosis: independent relationsto global severity and rate of progression of angiographic lesions in men with myocardial infarction at a young age. Am Heart J 1992;123:609-16. | ||
|
Statistics Article View: 200 PDF Download: 239 |
||
