Study of prognostic value of various biomarkers (creatinine phosphokinase - MB, C - reactive protein) and admission neutrophil lymphocyte ratio in early outcome of patients with acute myocardial infarction

Introduction: Coronary artery disease (CAD) continues to be a major cause of morbidity and mortality in developed as well as developing countries. The time course of bio-marker (protein) release during acute myocardial infarction provides diagnostic information which in turn is helpful in evaluating therapeutic interventions. The three easily measurable markers e.g. creatinine phosphokinase - MB (CPK-MB), C -reactive protein (CRP) and neutrophil lymphocyte ratio (N: L) in patients of acute myocardial infarction (AMI) can be used for diagnosis as well as prognosis. Material and methods: Patients of acute myocardial infarction admitted in intensive coronary care unit (ICCU) of a General Hospital were included in the present study. Detailed clinical examination of each patient was done and after initiating oxygen inhalation and pain relieving therapy, following investigations were sent; hemoglobin level, total white blood cell (WBC) count, differential count, CPK -MB, CRP level. Observation: Significantly high CPK - MB levels (>60 IU/L) were observed in 24% of patients who had or later developed complication of MI while only 7% of uncomplicated MI patients had significantly elevated levels of CPK - MB. Similarly more patients in complicated MI had higher values of CRP and N: L ratio as compared to uncomplicated MI patients. Conclusion: Blood levels of biomarker CPK - MB and inflammation markers CRP and N: L ratio at the time of hospital admission does have a direct correlation with chances of development of complications and/or mortality in early post-infarct period. These bio-chemical markers are important not only for diagnosis but also have prognostic values and help in risk stratification and decision making regarding further early therapeutic intervention.