(Circulation. 1999;99:855-860.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Elevated Levels of C-Reactive Protein at Discharge in Patients With Unstable Angina Predict Recurrent Instability
From the Institute of Cardiology and Institute of Microbiology Catholic University of the Sacred Heart (R.L.G., G.F.), Rome, Italy.
Correspondence to Luigi M. Biasucci, Istituto di Cardiologia, Universitá Cattolica del S Cuore, Largo Francesco Vito 1, 00168 Roma, Italy. E-mail biasucci{at}pelagus.it
Background—In a group of patients admitted for unstable angina, we investigated whether C-reactive protein (CRP) plasma levels remain elevated at discharge and whether persistent elevation is associated with recurrence of instability.
Methods and Results—We measured plasma levels of CRP, serum
amyloid A protein (SAA), fibrinogen, total cholesterol, and
Helicobacter pylori and
Chlamydia pneumoniae antibody titers in
53 patients admitted to our coronary care unit for Braunwald
class IIIB unstable angina. Blood samples were taken on admission, at
discharge, and after 3 months. Patients were followed for 1 year. At
discharge, CRP was elevated (>3 mg/L) in 49% of patients; of these,
42% had elevated levels on admission and at 3 months. Only 15% of
patients with discharge levels of CRP <3 mg/L but 69% of those with
elevated CRP (P<0.001) were readmitted because of
recurrence of instability or new myocardial infarction. New
phases of instability occurred in 13% of patients in the lower tertile
of CRP (
2.5 mg/L), in 42% of those in the intermediate tertile (2.6
to 8.6 mg/L), and in 67% of those in the upper tertile (
8.7 mg/L,
P<0.001). The prognostic value of SAA was similar to
that of CRP; that of fibrinogen was not significant.
Chlamydia pneumoniae but not
Helicobacter pylori antibody titers
significantly correlated with CRP plasma levels.
Conclusions—In unstable angina, CRP may remain elevated for at
3 months after the waning of symptoms and is associated with
recurrent instability. Elevation of acute-phase reactants in unstable
angina could represent a hallmark of subclinical persistent
instability or of susceptibility to recurrent instability and, at least
in some patients, could be related to chronic Chlamydia
pneumoniae infection.
Key Words: angina • prognosis • Chlamydia pneumoniae
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