# C-reactive Protein (CRP) Levels as a Predictor of Adverse Cardiovascular Events in Acute Myocardial Infarction: A Prospective Study

## TL;DR

This study shows that high C-reactive protein (CRP) levels at admission predict worse outcomes in heart attack patients within 30 days.

## Contribution

The study demonstrates CRP as an independent predictor of adverse cardiovascular events in acute myocardial infarction patients.

## Key findings

- Elevated CRP levels (>10 mg/L) were significantly linked to higher 30-day MACE rates (42.2%) compared to lower CRP groups.
- CRP was confirmed as an independent predictor of MACE with an adjusted odds ratio of 1.18 per 1 mg/L increase.
- Age, troponin levels, and time to hospital admission were also significant predictors of adverse outcomes.

## Abstract

Introduction

Acute myocardial infarction (AMI) is a major cause of illness and mortality around the world. Anti-inflammatory biomarkers, especially C-reactive protein (CRP), which indicate the degree of cardiac injury and systemic inflammation, have been proposed as predictors of poor cardiovascular outcomes.

Objective

The main objective of this study is to evaluate the role of CRP levels at admission as a predictor of 30-day major adverse cardiovascular events (MACE) in patients with AMI.

Methodology

This prospective observational cohort study was conducted at Lady Reading Hospital and Medical Teaching Institute, Peshawar, Pakistan, over a 12-month period. A total of 200 patients presenting with confirmed AMI were enrolled. Baseline demographics, clinical characteristics, and laboratory parameters, including serum CRP, were recorded. Patients were stratified into three CRP groups: <5 mg/L, 5-10 mg/L, and >10 mg/L. The selected thresholds were based on established clinical interpretations of inflammatory activity, where CRP levels <5 mg/L indicate minimal inflammation, 5-10 mg/L reflect moderate inflammation, and >10 mg/L represent marked systemic inflammation, typically associated with acute disease states. The primary outcome was 30-day MACE, including death, reinfarction, and heart failure. Statistical analyses included Chi-square tests, one-way analysis of variance (ANOVA), and multivariable logistic regression to adjust for potential confounders.

Results

The mean age was 57.8 ± 10.6 years, with 132 (66%) males. Elevated CRP levels (>10 mg/L) were significantly associated with a higher incidence of MACE (19, 42.2%) compared to the moderate (21, 24.7%) and low CRP groups (6, 8.6%) (p < 0.001). Multivariable logistic regression confirmed CRP as an independent predictor of 30-day MACE (adjusted OR: 1.18 per 1 mg/L increase, 95% CI: 1.09-1.27, p < 0.001), alongside age, troponin, and time to hospital admission.

Conclusion

Admission CRP levels are a strong independent predictor of short-term adverse outcomes in AMI patients, and can be used for early risk stratification and management decisions.