Predictor of event-free survival in patients with myocardial infarction.

BACKGROUND AND PURPOSE: The incidence of cardiovascular events remains high in patients with myocardial infarction (MI) despite advances in current therapies. New and better methods for identifying patients at high risk of recurrent cardiovascular events are needed. This study aimed to analyze the clinical predictors of cardiovascular events in patients with MI.

METHODS

The prospective cohort study consisted of 123 men and women aged between 31 and 80 years who had suffered a previous myocardial infarction (MI) 3-12 months before the examinations. The exclusion criteria were known diabetes mellitus and chronic inflammatory disease. Patients were followed up over 6.03 ± 1.36 years for CV death, recurrent MI, stroke and unstable angina pectoris. Plasma levels of high-sensitivity C-reactive protein (hs-CRP), total cholesterol and triglycerides were measured at the baseline. Echocardiography was performed.

RESULTS

hs-CRP was significantly higher (P < 0.05) and left ventricular ejection fraction (LVEF) was borderline significantly lower (P = 0.057) in patients with CV events compared with those without CV events. In multivariate statistical analysis and after adjustment for age, sex, total cholesterol, smoking, and other baseline characteristics, hs-CRP > 3 mg/l, (RR: 6.23, 95%CI: 1.47-26.39; P < 0.01) and LVEF (RR: 0.94, 95%CI: 0.88-1.00; P < 0.05) remain as independent predictors of CV events.

CONCLUSIONS

In this study population with previous MI an elevated hs-CRP > 3 mg/l and left ventricular dysfunction were significant predictors of CV death, recurrent MI, stroke and unstable angina pectoris, independent of baseline characteristics and medical treatment. Data from the study suggest that hs-CRP levels ≥ 3 mg/l and baseline ejections fraction can be used to stratify individuals at high risk of adverse CV events from patients with stable and asymptomatic coronary artery disease (CAD).