PREDICTIVE VALUE OF C-REACTIVE PROTEIN FOR THROMBOLYTIC THERAPY IN ACUTE MYOCARDIAL INFARCTION

Abstract

Abstract

The serum levels of C-reactive protein on admission may predict the efficacy of reperfusion in patients with acute myocardial infarction.

Objectives:  This study was conducted to know the predictive value of CRP for success of thrombolysis and to know the prognostic value of C-reactive protein in patients having acute myocardial infarction.

Study Design:  It was single center, open labeled cross sectional study.

Materials and Methods:  Sixty patients of acute myo-cardial infarction diagnosed on clinical and ECG cri-teria, who received thrombolytic therapy with strepto-kinase, were included in the study. The diagnosis of acute myocardial infarction was made on clinical para-meters and ECG criteria. The ECG changes were not-

Majeed N.¹

Assistant Professor Medicine

Department of Medicine / CCU, Services Institute of Medical Sciences / Services Hospital, Lahore

Ahmad K.²

Specialist Intensivist

SICU-Trauma Center, Rashid Hospital, Dubai

 Bashir F.³

Associate Professor Pathology

Services Institute of Medical Sciences / Services Hospital, Lahore

ed before starting thrombolysis. The baseline sample for C-reactive protein (CRP₁) was taken before star-ting thrombolysis. The time duration between onset of symptoms and start of thrombolysis was also noted. The thrombolysis was done with streptokinase infus-ion, 1.5 million units diluted in 100ml normal saline, intravenously over one hour. The ECG was repeated after six hours of completion of thrombolysis and, changes were noted and compared with ECG changes before thrombolysis. Now second sample for C-reac-tive protein (CRP₂) was taken after six hours of com-pletion of thrombolysis. CRP was measured by a high sensitivity assay which can accurately measure basal levels of CRP throughout the currently accepted car-diovascular risk assessment range (0.20 - 10.0 mg/L). According to ECG findings after thrombolysis, all pat-ients were divided into two groups. Group A was con-sidered as successful group to thrombolysis, in whom ECG changes were settled. Group B was considered as unsuccessful group to thrombolysis, in whom ECG changes remained same as before thrombolysis.Both values of C-reactive protein, CRP₁ and CRP₂ were compared in both groups group A and group B.

Results:  Plasma CRP values before and after thro-mbolysis had strong predictive value for success of thrombolysis, 63.3% (P value 0.002) and 93.3% (P value <0.001) respectively.

Conclusion:  In addition to ECG, C-reactive protein is a strong predictor of response of thrombolytic therapy in patients with acute myocardial infarction.

Key words:  Acute coronary syndrome, high - sensi-tivity - reactive protein, Myocardial infarction.

Abbreviations and Acronyms:  hs-CRP (high - sen-sitivity C-reactive protein), CRP (C-reactive protein), ACS (acute coronary syndrome), AMI (acute myocar-dial infarction).