Author(s)

Christoph Liebetrau Liebetrau, Luise Gaede, Sebastian Szardien, Johannes Rixe, Oliver Doerr, Matthias Willmer, Michael Weber, Andreas Rolf, Helge Möllmann, Albrecht Elsässer, Christian Hamm, Holger Nef

Department of Cardiology and Angiology, Faculty of Medicine, Justus-Liebig University of Giessen, Giessen, Germany..
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.

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 AF.Methods: 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.

Acute Coronary Syndrome; Atrial Fibrillation; Risk Stratification; High-Sensitivity CRP

C. Liebetrau, L. Gaede, S. Szardien, J. Rixe, O. Doerr, M. Willmer, M. Weber, A. Rolf, H. Möllmann, A. Elsässer, C. Hamm and H. Nef, "High Sensitivity CRP Predicts Long-Term Mortality in Patients with Atrial Fibrillation and Evident Acute Coronary Syndrome," International Journal of Clinical Medicine, Vol. 4 No. 3, 2013, pp. 137-144. doi: 10.4236/ijcm.2013.43025.