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C-reactive protein in unstable angina: clinical and angiographic correlation
Prashanth Panduranga1, Abdulla A Riyami1, Kadhim J Sulaiman1
1Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Insights
Elevated C-reactive protein (CRP) in unstable angina patients predicts more cardiac events and severe coronary artery disease (CAD). This finding supports using CRP for risk stratification and guiding angiography decisions.
Area of Science:
- Cardiology
- Biomarkers
- Inflammation
Background:
- Unstable angina (UA) is a critical condition requiring accurate risk stratification.
- C-reactive protein (CRP) is an inflammatory marker, but its prognostic role in UA needs further clarification.
- Troponin T is used to rule out myocardial necrosis, but other markers may offer additional prognostic information.
Purpose of the Study:
- To determine the prevalence of elevated CRP in UA patients.
- To assess the prognostic significance of CRP on in-hospital cardiac events.
- To evaluate the correlation between CRP levels and the severity of coronary artery disease (CAD) via angiography.
Main Methods:
- Prospective observational study of 100 unstable angina patients.
- CRP levels measured at admission using rate nephelometry (≥10 mg/l considered elevated).
- Patients were assessed for in-hospital cardiac events and severity of CAD, with comparisons between CRP-elevated and non-elevated groups.
Main Results:
- 42% of patients had elevated CRP (≥10 mg/l).
- Elevated CRP was associated with significantly more anginal episodes, myocardial infarction, in-hospital mortality, and severe triple-vessel disease compared to normal CRP levels.
- Elevated admission CRP demonstrated high sensitivity and specificity for predicting in-hospital cardiac events and significant CAD.
Conclusions:
- Raised admission CRP levels are predictive of increased in-hospital cardiac events and severe CAD in unstable angina patients.
- CRP serves as an independent risk stratification tool for unstable angina, even when troponin levels are normal.
- Patients with elevated CRP should be considered for coronary angiography during their index admission.
Objective:
To assess prevalence, in-hospital prognostic significance and angiographic correlation of C-reactive protein (CRP) elevation in patients with unstable angina.
Design:
Prospective observational study.
Setting:
Royal Hospital, Muscat, Oman.
Patients:
100 patients admitted between July 2008 and January 2009.
Interventions:
Patients with unstable angina and ECG changes without biochemical evidence of necrosis (negative first troponin T), had CRP measured at admission by rate nephelometry (≥10 mg/l abnormal).
Main Outcome Measures:
In-hospital cardiac events and severity of coronary artery disease (CAD) in patients with and without CRP elevation.
Results:
42% had CRP elevation ≥10 mg/l (Group I), and 58% had levels <10 mg/l (Group II). When compared with Group II, Group I patients had more anginal episodes (mean=4.6±2.5 episodes/patient vs 1.6±2.4; p<0.0001), myocardial infarction (58% vs 17%; p<0.01), in-hospital mortality (9% vs 0%; p=0.03) and severe triple vessel disease (71% vs 24%; p<0.01), and a higher total number of events (86% vs 24%; p<0.0001). Elevated admission CRP as a marker of in-hospital cardiac events showed a sensitivity of 72%, specificity of 88% and positive predictive value of 85%, and, as a marker of significant CAD, showed a specificity of 83% and a positive predictive value of 85%.
Conclusions:
Raised admission CRP level is predictive of increased in-hospital cardiac events and severe CAD in patients with unstable angina. CRP can be used to risk-stratify unstable angina patients independent of troponin levels. Patients with abnormal CRP should undergo coronary angiography either on-site or transferred to a centre with catheterisation facility during the index hospital admission.
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