Cardiology and Angiology: An International Journal

Introduction: Inflammation plays a key role in the initiation and progression of atherosclerosis. A few inflammatory biomarkers have been associated with cardiovascular outcomes, both in healthy individuals and in patients with established coronary heart disease and high-sensitivity C-reactive protein (hsCRP) has been identified as a more important prognostic biomarker than low-density lipoprotein (LDL) cholesterol.

Aims: The study aimed to investigate whether variations in inflammatory markers at the time of an Acute Coronary Syndrome (ACS) event are linked to patient prognosis.

Materials and Methods: An observational prospective study was conducted with 118 patients diagnosed with ACS, admitted to the intensive care unit at ERRAZI hospital from January 2024 to June 2024. The inclusion criteria were: patients between 41 and 84 years old, with confirmed ACS (unstable angina, ST-segment elevation myocardial infarction (STEMI), or non–ST-segment elevation myocardial infarction patients (NSTEMI)), and who provided informed consents. The outcome measure was the development of heart failure during follow-up. Statistical analyses were performed using Microsoft Excel and IBM SPSS software, with significance at p < 0.05.

Results: The study involved 118 patients, with a median age of 61.5 years. The majority were male (94 men, sex ratio of 3.91). 94 patients had MI and 24 had unstable angina. Common risk factors included smoking (64 patients), hypertension (46 patients), and diabetes (58 patients). The study found the following outcomes:50% of patients experienced pump failure. 22% had thrombolysis, with 9% experiencing failure.84 patients received PCI, 15 had CABG, and 19 were treated medically due to complex coronary anatomy. Short-term cardiovascular mortality (<29 days) was 16%, with causes including cardiogenic shock, uncontrolled arrhythmias, and severe metabolic disorders. Platelet counts ranged from 54,000 to 710,000 but this was not significantly linked to ACS outcomes. However, hs-CRP levels were significantly elevated (median: 45.04), and elevated hs-CRP, white blood cell count, and serum cholesterol were associated with a higher probability of adverse cardiac outcomes.

Discussion: Cardiovascular disease (CVD), particularly coronary heart disease (CHD), is the leading cause of death globally. Inflammation plays a crucial role in the onset and progression of CHD, with CRP being a key inflammatory biomarker. Studies have shown that elevated hs-CRP levels at the time of an ACS event are associated with both short-term and long-term mortality, and CRP is an important predictor of adverse cardiovascular outcomes. Additionally, blood cell profiles (such as neutrophils and monocytes) have been shown to predict mortality.

While hs-CRP is linked to the severity of ACS events, its predictive power is modest, and its addition to traditional risk factors (age, smoking, cholesterol) provides only slight improvements in risk assessment.

Those results suggest that anti-inflammatory therapies might reduce ischemic events after myocardial infarction.

Conclusion: CRP, particularly hs-CRP, has proven to be an important biomarker in ACS, with elevated levels correlating to a higher risk of heart failure both in the short and long term. While hs-CRP is not specific to heart failure, it provides valuable prognostic information and can help guide clinical decision-making. However, further research is needed to fully understand the role of CRP in post-myocardial infarction heart failure and to explore the potential benefits of CRP-targeted therapies in improving long-term cardiovascular outcomes.