title: Inflammation and long-term mortality after non-ST elevation acute coronary syndrome treated with a very early invasive strategy in 1042 consecutive patients.
abstract: BACKGROUND
  This study sought to evaluate the predictive value of C-reactive protein (CRP) on long-term mortality in non-ST-elevation acute coronary syndromes (NSTACS) that were treated with a very early aggressive revascularization strategy.
  
  
  RESULTS
  We conducted a prospective cohort study in 1042 consecutive patients with NSTACS who were undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularization strategy within 24 hours. Levels of CRP were determined on admission. The patients were followed for a mean of 20 months. In-hospital mortality was significantly higher in patients with a CRP>10 mg/L (3.7% versus 1.2% with CRP<3 mg/L and versus 0.8% with CRP of 3 to 10 mg/L; relative risk for CRP>10 mg/L compared with CRP< or =10 mg/L was 4.2, 95% confidence interval [CI] was 1.6 to 11.0; P=0.004). The increase in mortality in patients with CRP>10 mg/L persisted during follow-up. Long-term mortality was 3.4% with CRP<3 mg/L, 4.4% with CRP between 3 and 10 mg/L, and 12.7% with CRP>10 mg/L (relative risk for CRP>10 mg/L compared with CRP< or =10 mg/L, 0.8; 95% CI, 2.3 to 6.2; P<0.001). In addition, Kaplan-Meier survival analysis demonstrated a significantly reduced survival at 4 years in patients with a CRP>10 mg/L (78% versus 88% for a CRP of 3 to 10 mg/L and versus 92% for CRP<3 mg/L; P<0.001 by log-rank). In a multivariate analysis, CRP was an independent predictor of long-term mortality. Patients with a CRP>10 mg/L had >4 times the risk of death (odds ratio, 4.1; 95% CI, 2.3 to 7.2).
  
  
  CONCLUSIONS
  CRP is a strong independent predictor of short and long-term mortality after NSTACS that are treated with very early revascularization.
authors.affiliation: Herz-Zentrum Bad Krozingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Mueller
authors.forename: Heinz J
authors.initials: HJ
authors.lastname: Buettner
authors.forename: John M
authors.initials: JM
authors.lastname: Hodgson
authors.forename: Stephan
authors.initials: S
authors.lastname: Marsch
authors.forename: André P
authors.initials: AP
authors.lastname: Perruchoud
authors.forename: Helmut
authors.initials: H
authors.lastname: Roskamm
authors.forename: Franz-Josef
authors.initials: FJ
authors.lastname: Neumann
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007249:Inflammation / Q000097:blood*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009204:Myocardial Revascularization; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate
chemical_list: D002097:C-Reactive Protein