[C-reactive protein as a coronary risk factor]

[Independent role of C reactive protein to predict major events at one-month and at one-year in acute coronary syndrome without ST elevation]

BACKGROUND AND OBJECTIVE

We intended to determine whether C-reactive protein (CRP) provides independent prognostic information after a non-ST elevation acute coronary syndrome.

PATIENTS AND METHOD

We prospectively studied 630 consecutive patients admitted with a diagnosis of non-ST elevation acute coronary syndrome. Cut-off values were: troponin I > 1 ng/ml (n = 354; 56%) and CRP > 11 mg/l (n = 273; 43%).

RESULTS

Within a one-year follow-up period, 56 (9%) cardiac deaths, 85 (13%) myocardial infarctions (MI) and 127 (20%) first major events were detected. Patients with increased CRP showed higher rates of death at one-month (8% vs 1%), death at one-year (15% vs 4%), myocardial infarction at one-month (8% vs 4%), myocardial infarction at one-year (19% vs 9%), major events at one-month (15% vs 5%) and major events at one-year (30% vs 13%). In the multivariate analysis, once adjusted for baseline and electrocardiogram data and for myocardial damage markers, CRP was an independent predictor of death at one-month (odds ratio [OR] 4.6) and death at one-year (OR = 2.7), major events at one-month (OR = 1.8) and major events at one-year (OR = 1.8). Troponin I predicted MI at one-month (OR = 2.5) and MI at one-year (OR = 2.2).

CONCLUSIONS

CRP provided independent information to predict major events in non-ST elevation acute coronary syndromes. Troponin I was a more powerful predictor of MI than PCR. The analysis of CRP and myocardial damage markers in the short-term and long-term risk stratification seems worthy.

[Chronic Chlamydia pneumoniae infection in patients with coronary disease. Relation with increased fibrinogen values]

BACKGROUND

A number of studies have suggested that infection with Chlamydia pneumoniae can play a role in development of atherosclerosis. The goal of this study was to know the prevalence of chronic C. pneumoniae infection, evaluated with IgG antibodies seropositivity, in Spanish patients with coronary disease and its association with inflammatory markers and cardiovascular risk factors.

PATIENTS AND METHOD

In 176 patients with coronary disease IgG and IgM antibodies to C. pneumoniae were determined by enzyme immunoassay. In addition, fibrinogen and C-reactive protein values were measured as inflammatory markers. Controls were 55 healthy subjects whose age was not different from patients. Seropositivity for C. pneumoniae was considered when indices of IgG and/or IgM antibodies were higher than mean plus two standard deviations of control values. Three patients with seropositivity for IgM were excluded.

RESULTS

In 126 patients and 2 controls a seropositivity against C. pneumoniae was proved (72.8% vs 4.2%; p < 0.001). Cardiovascular risk factors were not different in seropositive and seronegative groups of patients. Prevalence of hyperfibrinogenemia was higher in the former group (38.8% vs 19.1%; p = 0.01). The number of the patients with increased values of C-reactive protein was similar in both groups, although these values could be modified by treatment with statins. In multivariate analysis an association between seropositivity for C. pneumoniae and hyperfibrinogenemia was found (odds ratio [OR] = 2.42; 95% confidence interval, 1.07-5.48; p = 0.03) after adjusting for age, gender, smoking, hypertension, hypercholesterolemia and diabetes.

CONCLUSIONS

Chronic infection with C. pneumoniae in patients with coronary disease is very prevalent, and it is associated with increased fibrinogen values.