[Short-term prognosis of patients admitted for probable acute coronary syndrome without ST-segment elevation. Role of new myocardial damage markers and acute-phase reactants].
OBJECTIVE
The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed.


METHODS
We prospectively studied 385 consecutive patients admitted from our chest pain unit with a high-probability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded.


RESULTS
During admission, 15 deaths (3.9%) and 16 complicative infarctions (4.2%) occurred, for a total of 31 major events (death and/or infarction: 8.1%). Age (p = 0.03), insulin-dependent diabetes (p = 0.009), and C-reactive protein (p = 0.05) were independently related to death. Fibrinogen was related to infarction (p = 0.01); by fibrinogen quartiles: 1.4%; 1.4%; 2.9%, and 11.7% (p = 0.02). Age (p = 0.01), insulin-dependent diabetes (p = 0.02), and C-reactive protein (p = 0.04) were independent predictors of major events; by C-reactive protein quartiles: 1.4%; 5.5%; 5.4%, and 16.7% (p = 0.004). Troponin I was related to major events (p = 0.03), but it was not an independent predictor.


CONCLUSIONS
Acute-phase reactants add independent information to clinical variables in the short-term risk stratification of patients with an acute coronary syndrome. The predictive power of troponins is lower than that of other variables.
Bodí
Vicent
V
Servei de Cardiologia, Hospital Clínic i Universitari, València, Universitat de València, Spain. vicentbodi@hotmail.com
Facila
Lorenzo
L
Sanchis
Juan
J
Llácer
Angel
A
Núñez
Julio
J
Mainar
Luis
L
Gómez-Aldaraví
Ricardo
R
Monmeneu
José V
JV
Blasco
María L
ML
Sanjuan
Rafael
R
Insa
Luis
L
Chorro
Francisco J
FJ
D000208:Acute Disease; D000209:Acute-Phase Proteins; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis; D003627:Data Interpretation, Statistical; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D004562:Electrocardiography; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D013577:Syndrome; D013997:Time Factors; D019210:Troponin I / Q000097:blood
D000209:Acute-Phase Proteins; D015415:Biomarkers; D019210:Troponin I; D005340:Fibrinogen; D002097:C-Reactive Protein