Inflammation during acute coronary syndromes — Risk of cardiovascular events and bleeding

• Published in: International journal of cardiology 2019-07, Vol.287, p.13-18
• Main Authors: Nanchen, David, Klingenberg, Roland, Gencer, Baris, Räber, Lorenz, Carballo, David, von Eckardstein, Arnold, Windecker, Stephan, Rodondi, Nicolas, Lüscher, Thomas F., Mach, François, Muller, Olivier, Matter, Christian M.
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - complications; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - drug therapy; Acute coronary syndromes; Aged; Anti-Inflammatory Agents - adverse effects; Anti-Inflammatory Agents - therapeutic use; Biomarkers - blood; C-Reactive Protein - metabolism; Female; Follow-Up Studies; Hemorrhage - blood; Hemorrhage - chemically induced; Hemorrhage - epidemiology; HsCRP; Humans; Incidence; Inflammation; Inflammation - blood; Inflammation - etiology; Inflammation - prevention & control; Male; Prevention; Prognosis; Prospective Studies; Switzerland - epidemiology
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2019.03.049

Many parameters can affect the level of inflammation during acute coronary syndromes (ACS). We aimed to assess the one-year risk of major adverse cardiovascular events (MACE) and bleeding associated with elevated hsCRP levels during ACS, taking into account the severity of myocardial infarction, the timing of blood sampling and established long-term prognostic factors. We studied 1864 consecutive patients with ACS enrolled in a contemporary multicenter prospective cohort study in Switzerland. HsCRP levels were determined at hospital admission. One year after discharge MACE and bleeding events were assessed. Multivariable adjusted Cox proportional hazards were computed with age, sex, time from symptom onset to blood draw, body mass index, current smoking, hypertension, diabetes mellitus, pre-existing cardiovascular disease, history of inflammatory disease, LDL-cholesterol levels, type of ACS, left ventricular ejection fraction and GRACE 1.0 risk score. At one-year follow-up, 151 (8.1%) patients suffered MACE. Compared to patients with hsCRP below 2 mg/l, the risk of MACE was higher in patients with hsCRP levels between 2 and 5 mg/l, with a multivariate adjusted hazard ratio (HR) of 1.63 (95% confidence interval (CI) 0.93–2.84), in those with levels between 5 and 10 mg/l, with a HR of 2.80 (95% CI 1.58–4.96), and in those with levels above 10 mg/l, with a HR of 2.23 (95% CI 1.28–3.88). There was no difference in bleeding risk between the four groups. Systemic inflammation in the acute phase of myocardial infarction is an independent predictor for cardiovascular events, but not for bleeding. •HsCRP in acute coronary syndrome is associated with recurrent cardiovascular events.•HsCRP in acute coronary syndrome is not associated with bleeding events.•The timing of blood sampling did not modify these associations.•Anti-inflammatory drugs should be tested in the early phase of myocardial infarction.