In This Edition
- C-reactive protein levels predict death from cardiac causes after MI.
- SSRIs reduce risk for recurrent cardiac events in acute coronary syndrome.
- Vancomycin is as effective as metronidazole in routine treatment of C. difficile and superior in severe infection.
- Prevalence and severity of C. difficile are increasing in hospitalized patients in the U.S.
- Deviations in recommended enoxaparin dosing in NSTEMI result in worse outcomes.
- Most outpatient VTE events occur in recently hospitalized patients.
- Poor health literacy predicts mortality in older adults.
- A validated model predicts the risk for delirium at hospital discharge.
Background: Ultra-sensitive quantitative assessment of C-reactive protein (CRP), a surrogate marker of systemic inflammation, has previously been shown to predict plaque instability in acute coronary syndromes. Data are lacking as to whether this blood test can also predict subsequent risk of heart failure or death on presentation in patients admitted for acute myocardial infarction (MI).
Study design: Prospec-tive observational study.
Setting: Olmstead County, Minn.
Synopsis: Ultra-sensitive quantitative serum CRP levels were obtained a median of 6.1 hours following onset of symptoms in 329 patients admitted with acute MI. The patients were stratified into tertiles based levels of CRP less than 3 mg/L, 3-15 mg/L, and more than 15 mg/L.
Tertiles were similar in respect to age, male-predominance, most cardiac risk factors, body mass index, and electrocardiographic (EKG) changes. However, there were statistically significant differences between groups, particularly the frequency of diabetes (10.7%, 31.2%, and 38.0%), previous MI history (2.7%, 4.6%, and 9.3%), Killip class greater than one (15.2%, 31.2%, and 39.8%), peak cardiac enzyme levels (both were higher in the bottom tertile, and lowest in the top tertile), and likelihood of significant comorbidities (lower likelihood in the bottom tertile, higher likelihood in the top tertile).