• Rev Port Cardiol · Feb 2013

    High-sensitivity C-reactive protein predicts adverse outcomes after non-ST-segment elevation acute coronary syndrome regardless of GRACE risk score, but not after ST-segment elevation myocardial infarction.

    • Sergio Raposeiras Roubín, Barreiro Pardal Cristina C, Filomena Roubín-Camiña, Raymundo Ocaranza Sanchez, Ezequiel Alvarez Castro, Beatriz Paradela Dobarro, Jose María García-Acuña, Pablo Aguiar Souto, Michel Jacquet Hervet, Maria José Castromán, Isabel Arufe, Belén Outes, María Victoria Reino-Maceiras, Emad Abu Assi, and José Ramón González-Juanatey.
    • Department of Cardiology, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain. raposeiras26@hotmail.com
    • Rev Port Cardiol. 2013 Feb 1; 32 (2): 117-22.

    IntroductionAtherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS). C-reactive protein (CRP) is an acute phase protein that appears in the circulation in response to inflammatory cytokines. The present study investigated the association between high-sensitivity C-reactive protein (hsCRP) on admission and follow-up prognosis after an ACS.MethodsWe included 151 consecutive patients admitted to the coronary care unit with a diagnosis of ACS (47% ST-segment elevation myocardial infarction [STEMI]). The primary endpoint was the combination of cardiac death and myocardial reinfarction during the follow-up period (median 19.8 months, interquartile range 16.3-23.7 months).ResultsThe occurrence of follow-up events was significantly related to admission hsCRP level, which was an excellent predictor of cardiac death and reinfarction during follow-up (HR 1.091, 95% CI 1.014-1.174; p=0.019). Stratifying the population based on type of ACS, adjusted by variables associated with cardiac events in univariate analysis (hsCRP, diabetes, depressed ejection fraction and GRACE risk score), hsCRP proved to be an independent predictor of follow-up outcomes only in non-STEMI patients (HR 1.217, 95% CI: 1.093-1.356, p<0.001), not in STEMI patients. The best cutoff level of hsCRP to predict follow-up outcomes was 1.1mg/dl, with sensitivity of 77.8% and specificity of 63.2%.ConclusionAlthough the GRACE risk score is routinely used for stratification of patients with ACS, assessment of hsCRP may provide additional prognostic value in the follow-up of non-STEMI patients.Copyright © 2012 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

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