Relation of C-reactive protein to extent and complexity of coronary narrowing in patients with non-ST elevation acute coronary syndromes. A prospective cohort study.
BACKGROUND
Inflammatory markers have been associated with adverse clinical outcome in patients with acute coronary syndromes (ACS). In addition, angiographic plaque morphology and extension of coronary artery disease has been related to worse prognosis in this group of patients. The aim of the present study was to determine if the clinical prognostic value of C-reactive protein (CRP), an inflammatory marker, can by associated with the angiographic findings in patients with non-ST elevation ACS.


METHODS
This prospective multicenter cohort study included 1253 patients with non-ST elevation ACS. CRP, which was considered positive (+) if >/=3 mg/l, was measured at a median of 9 h from symptoms onset and were kept blinded until the end of the study. Coronary angiography was performed in 633 patients (50%). The presence of complex coronary lesions (CCLs) was defined as the presence of any of the following: thrombus (+), Thrombolysis In Myocardial Infarction (TIMI) flow </=2, and/or ulcerated plaque (UP). The extension of coronary disease was defined as one, two or three vessel disease.


RESULTS
CRP was found to be (+) in 354 patients (60%). CCLs were present in 266 patients (46%), 166 (47%) in CRP (+) and 100 (42%) in CRP negative (-) patients, P=0.31. There was also no association between the extension of coronary disease and the CRP levels.


CONCLUSIONS
In this large consecutive cohort of non-ST elevation ACS patients, CRP, an inflammatory marker, does not predict either the extension or the complexity of coronary disease. Even though CRP is a strong predictor of worse clinical outcome in patients with ACS, this could not be explained by the angiographic anatomic findings.
Navarro Estrada
José L
JL
Hospital Italiano, Buenos Aires, Argentina.
Gabay
José M
JM
Alvarez
José
J
Sztejfman
Carlos
C
Matas
Carlos Rojas
CR
Farrás
Alejandra
A
Sarmiento
Ricardo
R
Tettamanzi
Alejandro
A
Rapallo
Carlos
C
Mrad
Jorge
J
Botto
Fernando
F
Hirschson-Prado
Alfredo
A
De Miguel
Raúl
R
Guzmán
Luis A
LA
D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000097:blood* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome; D020107:Troponin T / Q000097:blood
D015415:Biomarkers; D020107:Troponin T; D002097:C-Reactive Protein