High Sensitivity CRP Predicts Long-Term Mortality in Patients with Atrial Fibrillation and Evident Acute Coronary Syndrome

作     者：Christoph Liebetrau Luise Gaede Sebastian Szardien Johannes Rixe Oliver Doerr Matthias Willmer Michael Weber Andreas Rolf Helge Mollmann Albrecht Elsasser Christian Hamm Holger Nef 

作者机构：Department of CardiologyKerckhoff Heart and Thorax CenterBad NauheimGermany Department of Cardiology and AngiologyFaculty of MedicineJustus-Liebig University of GiessenGiessenGermany 

出 版 物：《International Journal of Clinical Medicine》 (临床医学国际期刊（英文）)

年 卷 期：2013年第4卷第3期

页      面：137-144页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Acute Coronary Syndrome Atrial Fibrillation Risk Stratification High-Sensitivity CRP 

摘      要：Background: Atrial fibrillation (AF) is a frequent arrhythmia associated with an adverse prognostic value in patients with ACS. Risk stratification as well as diagnosis of ACS is strongly supported by biomarkers. High sensitivity CRP (hs-CRP) is known to be elevated in patients presenting with ACS as well as with ***: In total, 2034 consecutive patients with an ACS were analysed. The incidence of AF in the setting of ACS, the prognostic value of hs-CRP and the clinical outcome within 6 months were subject of the study. Death after 6 months was considered as primary endpoint. Results: The frequency of AF among patients admitted with suspected ACS was 124 (6.1%). During 6-month follow-up the mortality rate among patients with AF was significantly higher (20 [16.1%] vs 133 [6.9%];log-rank 13.72;p 0.001) compared to patients without AF. Cox regression analysis revealed an increased risk for ACS patients with AF with an adjusted HR of 2.63 (95% CI 1.48 - 3.78;p 0.001). Patients with AF showed significant higher levels of hs-CRP than patients without AF (6.01mg/dl IQR [1.7 - 17.8] vs 3.3mg/dl IQR [1.37 - 9.83];p = 0.003). By the use of multivariate Cox regression analysis, risk of mortality was higher when AF patients had higher concentrations of hs-CRP (HR 1.076;95% CI 1.02 - 1.13;p = 0.002).Conclusions: AF is a strong and independent indicator for increased mortality in patients presenting with ACS. hs-CRP predicts mortality in AF patients and should be considered for risk stratification in clinical routine.