C-reactive protein as a predictor of malignant ventricular arrhythmias in non-ST elevation myocardial infarction
Cheng-Gang Wang1, Xiu-Chuan Qin1, Shao-Ping Nie1
1Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
High-sensitivity C-reactive protein (hs-CRP) can identify malignant ventricular arrhythmias (MVA) in non-ST elevation myocardial infarction (NSTEMI) patients with low GRACE scores. This hs-CRP assay may aid in risk stratification for these patients.
Area of Science:
- Cardiology
- Biomarker Discovery
- Acute Coronary Syndromes
Background:
- Malignant ventricular arrhythmias (MVA) pose a significant risk in non-ST elevation myocardial infarction (NSTEMI) patients.
- Risk stratification in low-risk NSTEMI patients (GRACE score < 140) requires reliable biomarkers.
Purpose of the Study:
- To evaluate high-sensitivity C-reactive protein (hs-CRP) as a potential biomarker for MVA in NSTEMI patients with GRACE scores below 140.
- To determine the diagnostic performance of hs-CRP in identifying MVA in this specific patient cohort.
Main Methods:
- A cohort of 1450 NSTEMI patients with GRACE scores < 140 was analyzed.
- Serum hs-CRP levels were measured using turbidimetric immunoassay.
- Statistical analysis, including receiver operating characteristic (ROC) analysis, was performed to assess hs-CRP's discriminatory power.
Main Results:
- MVA occurred in 6.7% of patients, associated with reduced ejection fraction, higher Killip classification, increased revascularization, and mortality.
- Serum hs-CRP levels were significantly higher in NSTEMI patients with MVA (P = 0.003).
- An hs-CRP cutoff of 16 mL/L demonstrated high sensitivity (95%) and negative predictive value (99%) for MVA detection.
Conclusions:
- Hs-CRP is a potential biomarker for MVA in low-risk NSTEMI patients (GRACE score < 140).
- Hs-CRP may serve as a cost-effective supplementary tool for risk stratification in NSTEMI patients.
- Prospective validation studies are recommended to confirm these findings.
Objective:
To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occurring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores < 140.
Methods:
A total of 1450 NSTEMI patients were included in this study. Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores < 140.
Results:
Consistent with prior studies, the MVA occurrence rate in our cohort was 6.7%, and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1% ± 6.9% vs. 61.5% ± 8.7%, P = 0.032), a higher incidence of Killip classification > 1 (34.1% vs. 24.2%, P < 0.001), an increased surgical revascularization rate (34.1% vs. 9.7%, P < 0.001), and increased mortality (16.5% vs. 5.8%, P < 0.001). Serum hs-CRP levels were higher (P = 0.003) in NSTEMI patients with MVA, and this increase appeared unrelated to other clinical parameters. The C-statistic to discriminate MVA was 0.82 (95% CI: 0.74-0.89). Using receiver operating characteristics analysis, we optimized a cutoff point of 16 mL/L, and the sensitivity and specificity were 95% and 61%, respectively; the positive predictive value was 20% and the negative predictive value was 99%.
Conclusions:
An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores < 140. If validated in prospective studies, hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.
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