• Luis Cláudio Lemos Correia, Isis Vasconcelos, Guilherme Garcia, Felipe Kalil, Felipe Ferreira, André Silva, Ruan Oliveira, Manuela Carvalhal, Caio Freitas, and Márcia Maria Noya-Rabelo.
• Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
• Arq. Bras. Cardiol. 2014 May 1; 102 (5): 449-55.

BackgroundThe incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation.ObjectiveTo test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS.MethodsA total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina.ResultsThe incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15).ConclusionAlthough CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score.

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