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Independent prognostic value of elevated C-reactive protein in unstable angina
E R Ferreirós1, C P Boissonnet, R Pizarro
1Servicio de Cardiología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Insights
C-reactive protein (CRP) levels in unstable angina patients predict 90-day risk. CRP measured at hospital discharge is a stronger predictor of adverse outcomes than CRP at admission, aiding risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Growing evidence suggests C-reactive protein (CRP) is prognostically important in unstable angina.
- The independent predictive value of CRP relative to other markers at various treatment stages remains unclear.
- This study aimed to evaluate the in-hospital and 90-day prognostic significance of serum CRP in unstable angina patients.
Purpose of the Study:
- To assess the prognostic value of serum C-reactive protein (CRP) in unstable angina.
- To compare the predictive ability of CRP levels at admission versus discharge for 90-day outcomes.
- To determine if CRP is an independent marker of risk in this patient population.
Main Methods:
- 194 unstable angina patients were analyzed in derivation (n=105) and validation (n=89) sets.
- Serum CRP levels were measured at admission, 48 hours, and hospital discharge.
- Receiver operator curves determined an optimal CRP cutoff of 1.5 mg/dL for adverse outcomes.
Main Results:
- No association was found between admission CRP and in-hospital outcomes.
- Admission CRP, adjusted for clinical factors, predicted 90-day adverse events (refractory angina, myocardial infarction, death; HR 1.9, P=0.002).
- Discharge CRP was the strongest independent predictor of 90-day adverse outcomes (HR 3.16, P=0.0001), confirmed in the validation set (HR 3.3, P=0.0001).
Conclusions:
- C-reactive protein (CRP) is a significant independent marker for increased 90-day risk in unstable angina.
- CRP levels at hospital discharge offer superior prognostic value for later outcomes compared to admission levels.
- Discharge CRP measurements can significantly enhance risk stratification for unstable angina patients.
Background:
There is growing evidence of the prognostic importance of C-reactive protein (CRP) in unstable angina. However, the independent value of CRP relative to other conventional markers at different stages of treatment has not been established. Therefore, we assessed the in-hospital and 90-day prognostic values of serum CRP in unstable angina. We also compared the relation of CRP at admission and discharge with 90-day outcome.
Methods And Results:
One hundred ninety-four consecutive patients were included in a derivation (n = 105) and a validation set (n = 89). Serum CRP was measured at admission, at 48 hours, and at hospital discharge. A cutoff point of 1.5 mg/dL for CRP provided optimum sensitivity and specificity for adverse outcome, based on the receiver operator curves. No association was found between CRP on admission and in-hospital outcome. CRP at admission, adjusted for age, ECG findings on admission, silent ischemia, left ventricular wall motion score, and high-risk clinical presentation, was related to the combined end point of refractory angina, myocardial infarction, or death at 90 days (hazard ratio [HR] 1.9, 95% CI 1.2 to 8.3, P = 0.002). CRP at hospital discharge was the strongest independent marker of an adverse outcome (HR 3.16, 95% CI 2.0 to 5.2, P = 0.0001). These results were confirmed in the validation set (CRP at discharge: HR 3. 3, 95% CI 2.0 to 7.69, P = 0.0001).
Conclusions:
In unstable angina, CRP is a strong independent marker of increased 90-day risk. Compared with CRP at admission, CRP at discharge is better related to later outcome and could be of great utility for risk stratification.
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