| Prognostic significance of 1-year versus baseline high-sensitivity C-reactive protein after acute myocardial infarction: nationwide landmark results |
Seok-Woo Seong1, Hyun Woong Park1
, Jae-Hwan Lee1, Jin-Ok Jeong1, Mi Joo Kim1, Pil Sang Song1, Seon-Ah Jin1, Kye Taek Ahn1, Myung Ho Jeong2, Sang Hyun Park3, Jin-Yong Hwang4, and KAMIR Investigators |
1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
2Division of Cardiology, Department of Internal Medicine, Heart Center, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
3Department of Internal Medicine and Cardiovascular Center, Daejeon Eulji University Hospital, Daejeon, Korea
4Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea |
Corresponding Author:
Hyun Woong Park , Tel: +82-42-280-8796, Fax: +82-42-280-6760, Email: chunjium@hanmail.net
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Received: November 10, 2025; Revised: January 11, 2026; Accepted: March 9, 2026. |
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| Abstract |
Background/Aims: Residual inflammatory risk after acute myocardial infarction (AMI) remains an important determinant of long-term outcomes despite optimal lipid-lowering therapy. The prognostic significance of serial high-sensitivity C-reactive protein (hs-CRP) measurements beyond the acute phase remains unclear. This study compared baseline and 1-year hs-CRP for predicting 3-year major adverse cardiovascular events in patients with AMI undergoing percutaneous coronary intervention.
Methods: We analyzed a large prospective AMI registry in which hs-CRP was measured at baseline and 1 year, classifying patients at each time point using a ≥ 2 mg/L threshold. The primary endpoint was 3-year MACE, including cardiovascular death, recurrent myocardial infarction, stroke, repeat revascularization, and stent thrombosis.
Results: Among 16,371 patients, 9,618 (58.8%) had elevated hs-CRP at baseline. Of the 5,389 patients with 1-year data, 28.9% had elevated hs-CRP. Baseline hs-CRP predicted MACE within the first year (hazard ratio [HR] 1.38, 95% CI 1.21–1.57); however, this association was no longer significant beyond 1 year. One year hs-CRP independently predicted subsequent 2-year MACE (HR 1.33, 95% CI 1.01–1.77). Patients with persistently high hs-CRP (≥ 2 mg/L at both time points) had the highest 3-year MACE risk (HR 1.49, 95% CI 1.08–2.06, p = 0.015 vs. persistently low group) than patients with recovered, worsening, and persistently low hs-CRP.
Conclusions: In patients with AMI, hs-CRP measured at 1-year provides stronger long-term prognostic information than that at baseline beyond 1 year. Routine assessment of hs-CRP may improve risk stratification and guide targeted anti-inflammatory strategies in secondary prevention. |
| Keywords:
Myocardial infarction ; C-reactive protein ; Inflammation ; Risk assessment |
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