the study of association of c- reactive protein and ldl-c/hdl-c ratio in acute myocardial infarction dr

102 Pages·2013·2.32 MB·English

THE STUDY OF ASSOCIATION OF C- REACTIVE
PROTEIN AND LDL-C/HDL-C RATIO IN ACUTE
MYOCARDIAL INFARCTION

By
DR. JAGADISH NAYAK.,
M.B.B.S
Dissertation Submitted to the
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
In partial fulfilment of the requirements for the

DOCTOR OF MEDICINE
IN
GENERAL MEDICINE
Under the guidance of
DR. MOHAMED GHOUSE SHARIFF,
M. D
Professor and Head, Department of Medicine

DEPARTMENT OF MEDICINE
MYSORE MEDICAL COLLEGE
MYSORE
2014
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ACKNOWLEDGEMENTS
With deep sense of gratitude and thankfulness, I express my indebtedness to
my revered teacher, Dr.H.HANUMANTHAPPA., ,Dean and Director,
M.D. D.V.D
Mysore Medical College and Research Institute, Mysore, who has been a constant
source of inspiration and encouragement and had provided invaluable guidance in the
successful completion of this dissertation.
I like to thank Dr.B.G.SAGAR .,Medical Superintendent, K.R Hospital,
M.S
Mysore, for his profound support in the completion of this dissertation.
I like to thank Dr. MOHAMMED GHOUSE SHARIFF. Professor and
Head, Department of Medicine, Mysore Medical College and Research Institute,
Mysore, for his profound support in the completion of this dissertation.
I’m thankful to Dr. M.A.SHEKAR, Chairman of Scientific Committee,
Mysore Medical College and Research Institute, Mysore and Ethical Committee,
Mysore Medical College Research Institute, Mysore for their support
I would like to thank Dr. A.G. RAVISHANKAR, Dr. M.A. SHEKAR,
Dr. SRINIVASA M., Professors of Medicine; Dr. J. INBANATHAN,
Dr.D K SUNEETHA, Dr. MANJULA A, Associate Professor of Medicine;
Dr. SURESH K,Associate professor of Neurology, Dr. M.M. BASAVARAJU,
Dr. S.S. RAMESH, Dr. RANGASWAMY, Dr. VIKAS L, DR.RAVI CHETHAN
KUMAR, Dr. YOGANNA, Assistant Professors of Medicine, Dr.VANDANA
BALGI, Dr. MANJUNATH and Dr. RIYAZ, senior residents of medicine
Dr.LATHA, Junior resident of medicine for their suggestions in preparing this
dissertation.
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LIST OF ABBREVIATIONS USED
ACC : American College of Cardiology
ACS : Acute coronary syndromes
AMI : Acute myocardial infarction
CAD : Coronary artery disease
CRP : C - reactive protein
DASH : Dietary approaches to stop hypertension
ESR : Erythrocyte sedimentation rate
HDL-C : High Density Lipoproteins
IHD : Ischemic heart disease
IL : Interleukins
LAD : Left anterior descending coronary artery
LCA : Left coronary artery.
LCX : Left circumflex coronary artery.
LDL-C : Low Density Lipoproteins
NSTEMI : non-ST segment elevation myocardial infarction
RCA : Right coronary artery.
STEMI : ST segment elevation myocardial infarction
TC : Total Cholesterol
TG : Triglycerides
tPA : Tissue Plasminogen activator
UA : Unstable angina.
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ABSTRACT
Background & Objectives
The incidence of coronary artery disease is increasing in India. So we are in
need of a tool to assess the severity and prognosis of these acute myocardial
infarction. The role of plaque rupture and inflammation has been already established
in acute myocardial infarction. C- reactive protein is a prototypical acute phase
reactant, whose levels are increased proportional to the extent of inflammation. This
study is done to measure the Association of C- reactive protein levels and LDL-
C/HDL-C ratio in acute myocardial infarction patients.
Methods
We studied 100 patients with acute myocardial infarction (STEMI and
UA/NSTEMI). Serum C reactive protein levels and LDL/HDL ratio were measured at
admission by qualitative method. Patients were followed up in hospital for mortality
and complications.
Results
There were 73 male and 27 female patients. Mean age for males was 58.16
years and for females was 56.74 years. STEMI was seen in 68 patients and 32 patients
had UA/NSTEMI. CRP were elevated in 76 patients, out of which 13 patients had
LDL/HDL ratio > 3 (p > .01). And among 32 patients in whom CRP were not
elevated, only 4 patients had LDL/HDL ratio > 3.

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Interpretation & Conclusion
Raised CRP levels and LDL/HDL ratio are independent markers of adverse
outcomes. Plasma CRP Levels and LDL/HDL ratio on admission serves to identify
high risk patients in the setting of acute myocardial infarction. The effective risk
stratification provided may be of specific value for early therapeutic decision making
and patient treatment in the heterogeneous population of patients presenting with
acute myocardial infarction.
Key words
Coronary artery diseases; acute myocardial infarction; C- reactive proteins;
myocardial infarction.

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