Enhanced Inflammation is a Marker for Risk of Post-Infarct Ventricular Dysfunction and Heart Failure

Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP(24)), discharge (CRP(DC)), and 1 month after discharge (CRP(1M)). LVSD at 6 months after discharge (LVSD(6M)) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD(6M) occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD(6M) vs. 4.9% without LVSD(6M) (p < 0.0001). Compared to patients without LVSD(6M), the patients with LVSD(6M) had higher CRP(24) and CRP(DC) and persistent CRP(1M) ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP(24) ≥ 19.67 mg/L improved the prediction of LVSD(6M) with an increased odds ratio of 1.47 (p < 0.01). Patients with LVSD(6M) who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.