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Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST
Luis C L Correia1, José C Lima, Mário S Rocha
1Medical School of Bahia, Scientific Development Foundation, Salvador-Bahia, Brazil. lccorreia@terra.com.br
Insights
C-reactive protein (CRP) measured upon hospital arrival provides valuable prognostic information for non-ST-elevation acute coronary syndromes (ACS). Adding CRP to the TIMI-Risk Score significantly improves cardiovascular event risk prediction and patient stratification.
Area of Science:
- Cardiology
- Biomarkers
- Risk Stratification
Background:
- Non-ST-elevation acute coronary syndromes (ACS) require accurate prognostic assessment.
- The TIMI-Risk Score is a standard tool for risk stratification in ACS.
- C-reactive protein (CRP) is an inflammatory marker with potential prognostic value in ACS.
Purpose of the Study:
- To evaluate the prognostic value of C-reactive protein (CRP) measured at hospital arrival in patients with non-ST-elevation acute coronary syndromes (ACS).
- To determine if CRP improves the prognostic accuracy of the TIMI-Risk Score for predicting in-hospital cardiovascular events.
Main Methods:
- Eighty-six patients with unstable angina or non-ST-elevation myocardial infarction were analyzed.
- Serum CRP levels were measured upon hospital admission.
- Prognostic value was assessed using ROC curve analysis and logistic regression, adjusting for TIMI risk predictors.
- A modified TIMI-Risk Score incorporating CRP was created and compared to the standard score.
Main Results:
- Admission CRP levels showed significant predictive value for in-hospital cardiovascular events (AUC=0.80, p=0.009).
- A CRP cut-off of 7.2 mg/l was identified for optimal prognostic performance.
- Elevated CRP (>7.2 mg/l) remained a significant independent predictor of events (OR=14, p=0.018).
- The TIMI-Risk Score had an AUC of 0.87 (p=0.001).
- Incorporating CRP into the TIMI-Risk Score significantly improved its prognostic value (AUC=0.93, p<0.001), increasing specificity and positive predictive value.
Conclusions:
- C-reactive protein measured at admission adds significant prognostic information to the TIMI-Risk Score in patients with non-ST-elevation ACS.
- Integrating CRP into risk stratification models enhances the accuracy of predicting cardiovascular events.
- The CRP-modified TIMI-Risk Score offers improved risk stratification for ACS patients.
Background:
C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score.
Methods:
Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score.
Results:
A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, p<0.001). The additional value of the new score is demonstrated by a higher specificity (86% vs. 63%, p<0.001) and positive predictive value (39% vs. 19%) in relation to the TIMI-Risk Score.
Conclusions:
CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification.
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