Analytical Study of Admission Inflammatory Markers and In-Hospital Events among Acute ST-Elevation Myocardial Infarction Patients

Background: ST-elevation myocardial infarction has high early complication risk, especially in patients presenting late or with haemodynamic instability. Admission inflammatory markers may help in simple risk stratification at medium-facility hospitals. Material and Methods: This retrospective observational study included 148 adult patients admitted with ST-elevation myocardial infarction. Admission high-sensitivity C-reactive protein, complete blood count, neutrophil–lymphocyte ratio, renal function, blood sugar, troponin I and echocardiographic left ventricular ejection fraction were recorded. Patients were followed during hospital stay for adverse cardiovascular events and mortality. Receiver operating characteristic curve analysis and logistic regression were used to assess predictors. Results: Adverse cardiovascular events occurred in 37 patients (25.0%) and in-hospital mortality occurred in 12 patients (8.1%). hs-CRP was higher in patients with adverse events than those without events [11.6 (5.9–23.4) vs 4.8 (2.1–9.7) mg/L, p<0.001]. hs-CRP was also higher in patients who died [18.9 (10.8–36.5) vs 5.8 (2.6–11.4) mg/L, p<0.001]. hs-CRP ≥6.0 mg/L independently predicted adverse cardiovascular events and hs-CRP ≥10.0 mg/L independently predicted in-hospital mortality. Conclusion: Admission hs-CRP was a useful inflammatory marker for early risk assessment in STEMI. Neutrophil–lymphocyte ratio showed supportive value but did not remain an independent predictor after adjustment. Bedside clinical severity, failed reperfusion and hs-CRP together may help in identifying high-risk patients. This approach is practical for Indian medium-facility hospitals.

Keywords: ST-elevation myocardial infarction; high-sensitivity C-reactive protein; neutrophil–lymphocyte ratio; adverse cardiovascular events.