C-reactive protein improves risk prediction in patients with acute coronary syndromes

Area of Science:

• Cardiology
• Biomarkers
• Risk Stratification

Background:

• Elevated C-reactive protein (CRP) is a known risk marker in acute coronary syndromes (ACS).
• Current risk score systems, such as the Global Registry of Acute Coronary Events (GRACE) score, do not incorporate CRP levels.
• Accurate risk stratification is crucial for managing ACS patients.

Purpose of the Study:

• To evaluate the incremental predictive value of adding C-reactive protein (CRP) to the GRACE risk score.
• To determine if CRP improves the risk classification of patients with acute coronary syndromes (ACS).

Main Methods:

• A cohort of 1408/1901 consecutive ACS patients had their characteristics, treatments, and 30-day mortality recorded.
• C-reactive protein (CRP) levels were analyzed, with high CRP defined as >22 mg/L (4th quartile).
• The GRACE risk score was assessed with and without the addition of high CRP, evaluating model fit, discrimination, calibration, and reclassification.

Main Results:

• High CRP patients were older, had more comorbidities, worse hemodynamic conditions, and received less recommended treatment.
• High CRP was an independent predictor of mortality, with a four-fold higher 30-day mortality rate.
• Adding high CRP to the GRACE score modestly improved global fit (c-statistic from 0.795 to 0.823) and reclassification in 12.2% of patients.

Conclusions:

• Elevated C-reactive protein (CRP) is a modest but independent predictor of 30-day mortality in ACS patients.
• CRP provides valuable prognostic information beyond traditional risk factors, comorbidities, hemodynamics, and treatment.
• Integrating CRP with the GRACE risk score enhances the accuracy of risk classification for ACS patients.