Relationship between High Sensitivity C-Reactive Protein Level and Angiographic Severity of the Disease in Stemi

INTRODUCTION: Over the last decade, cardiovascular disease (CVD) has become the single largest cause of death worldwide. They account for about 30% of all cause of death. IHD is the most common, serious, chronic, life-threatening illness in the world. Traditional risk factors include modifiable and non-modifiable risk factors. Non modifiable risk factors include age, sex, race, family history, personal history. Modifiable risk factors include cigarette smoking, obesity, Physical inactivity, Kidney disease, Diabetes mellitus, Alcohol consumption, Stress, elevated LDL, and reduced HDL. In recent years, new serum markers have been used in the diagnosis and risk stratification of patients with acute ischemic heart disease. These markers of myocardial damage are systematically employed in the diagnosis and prognosis of acute coronary syndromes. It has been suggested that inflammation influences the pathogenesis of atherosclerosis and the progression of acute coronary syndromes. Consequently, markers of inflammation are also used in prognostic stratification of acute coronary syndromes. Among these markers, C-reactive protein (CRP) is preferred because of its availability, stability, and prolonged average life. In this background a cross sectional study was done in 52 patients admitted with features of acute coronary syndrome. Hs-CRP was measured and level was compared to the angiographic severity of the lesion. AIMS AND OBJECTIVES: 1. To study the level of Hs-CRP in patient with acute coronary syndrome. 2. To study relationship between the level of Hs-CRP and disease severity graded by angiography. MATERIAL AND METHODS: Setting: This work was done at Government Rajaji Hospital, affiliated to the Madurai Medical College, Madurai. Collaborating. Department : Department of Medicine in collaboration with Departments of Cardiology and Biochemistry. Design of study : Cross Sectional and Analytical study. Period of study : April 2011 to October 2011. Sample size : 52 patients admitted with cardiology with diagnosis of acute coronary syndrome (STEMI) Selection of study subjects: Cases: First ever myocardial infarction patients admitted to Govt. Rajaji Hospital, who satisfied the inclusion criteria were selected for the study. Inclusion criteria: i. ECG changes suggestive of Acute Myocardial Infarction. ii. Echocardiography – presence of regional wall motion abnormalities. iii. Elevated enzymes – CPK. Exclusion criteria: i. Chronic Kidney Disease. ii. Extra cardiac Atherosclerosis. iii. Acute / chronic liver diseases. iv. Rheumatoid arthritis. v. Documented connective tissue disorders. vi. Previous h/o Myocardial Infarction / CAD. vii. Fever within 1 week prior to admission. viii. Skin infections / any other overt infections. ix. Malignancy. x. Children. xi. Pregnant women. CONCLUSION: 1. Sex ratio of male to female in this study is 7:3. 2. Highest incidence of myocardial infarction is in the age group of 46 – 55 years. 3. Women had higher incidence of myocardial infarction in the postmenopausal age. 4. CRP level is found consistently elevated in the patients developing myocardial infarction. 5. Significant positive correlation was observed between the extent of coronary artery disease and hs-CRP levels. Similarly hs-CRP levels were found to be higher in patients with higher degree of angiographic stenosis. This shows that hs-CRP levels have a positive correlation with the disease burden in CAD patients. Thus hs-CRP level may help in predicting the outcome of the patient admitted with acute myocardial infarction