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Predischarge C-reactive protein and 1-year outcome after acute coronary syndromes
Philippe Gabriel Steg1, Philippe Ravaud, Alain Tedgui
1Department of Cardiology, Hôpital Bichat, Paris, France. gabriel.steg@bch.ap-hop-paris.fr
Insights
Predischarge high-sensitivity C-reactive protein levels do not reliably predict cardiovascular events within one year after acute coronary syndrome. This finding suggests it
Area of Science:
- Cardiology
- Biomarkers
- Clinical Outcomes
Background:
- Acute coronary syndrome (ACS) is a critical cardiovascular condition.
- Identifying reliable predictors of post-ACS events is crucial for risk stratification.
- High-sensitivity C-reactive protein (hs-CRP) is a marker of inflammation.
Purpose of the Study:
- To evaluate the association between predischarge hs-CRP levels and cardiovascular events.
- To determine the predictive value of hs-CRP for 1-year outcomes after ACS.
Main Methods:
- Nationwide, prospective study of 439 patients with ACS.
- Exclusion of patients with concomitant inflammatory conditions.
- Measurement of predischarge hs-CRP using a high-sensitivity assay.
- Composite endpoint: death, myocardial infarction, stroke, unstable angina, or revascularization within 1 year.
Main Results:
- No significant difference in 1-year event rates across hs-CRP tertiles (P = .75).
- hs-CRP was not an independent predictor of 1-year cardiovascular events (HR: 1.19; 95% CI: 0.58-2.43).
- Receiver operating characteristic analysis showed poor predictive performance (C statistic = 0.51).
Conclusions:
- Predischarge hs-CRP levels are a poor predictor of 1-year cardiovascular events post-ACS.
- hs-CRP measurement may not be beneficial for risk stratification in this patient population.
Purpose:
To investigate the relationship between high-sensitivity C-reactive protein and cardiovascular events following acute coronary syndrome.
Methods:
This nationwide, cross-sectional, prospective study involved 439 patients with an acute coronary syndrome who presented to the hospital within 24 hours of symptom onset. Patients with a concomitant inflammatory process were excluded. Predischarge C-reactive protein samples were measured using a high-sensitivity method in a core laboratory. The outcome was the composite of death, acute myocardial infarction, stroke/transient ischemic attack, urgent hospitalization for unstable angina, and urgent revascularization within 1 year.
Results:
At 1 year, event rates were 10.2% for the lowest, 8.2% for the middle, and 11.0% for the highest C-reactive protein tertiles (P = .75) with similar event-free survival (P = .70). The hazard ratio (HR) for event rates between the highest and lowest tertiles was 1.10 (95% confidence interval [CI]: 0.54 to 2.20) There was marked overlap of C-reactive protein values between patients with and without events (median [interquartile range]: 8.39 [3.27 to 32.63] vs 9.55 [4.07 to 24.02], respectively; P = .91). C-reactive protein was not an independent predictor of 1-year events (HR for highest tertile: 1.19; 95% CI: 0.58 to 2.43; P = .64) and performed poorly on receiver operating characteristic curve analysis (C statistic = 0.51).
Conclusion:
Predischarge high-sensitivity C-reactive protein level is a poor predictor of cardiovascular events at 1 year after acute coronary syndrome.
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