Value of serial C-reactive protein measurements in non ST-segment elevation acute coronary syndromes

Elevated C-reactive protein (CRP) levels at admission are associated with adverse outcomes in patients with non ST-segment elevation acute coronary syndromes (NSTE-ACS).

C-reactive protein measurement not only at admission, but also after admission, may be useful for predicting adverse outcomes in NSTE-ACS.

We measured high-sensitivity CRP levels at admission and at 24 h in 215 patients with NSTE-ACS. An elevated CRP level at admission (admission elevation) was defined as a CRP level of >or=0.300 mg/dL. An increase in the CRP level after admission (increase at 24 h) was considered present when the CRP level at 24 h was higher than the level at admission. Patients were divided into 4 groups according to the presence or absence of admission elevation and increase at 24 h. Coronary angiography was performed at a mean of 3 d after admission.

There were no significant differences among the 4 groups in age, sex, coronary risk factors, or multivessel disease. Patients with both admission elevation and increase at 24 h had higher rates of ST-segment depression and positive troponin T at admission. Multivariate analysis showed that admission elevation (odds ratio [OR] 1.50, p<0.05) and increase at 24 h (OR 6.56, p=0.03) were independent predictors of 30-d events (e.g., death, myocardial infarction, or refractory angina). The highest risk of 30-d events was associated with both admission elevation and increase at 24 h.

Serial CRP measurements are useful for predicting the risk of subsequent ischemic complications in patients with NSTE-ACS.