Predischarge C-reactive protein and 1-year outcome after acute coronary syndromes.
OBJECTIVE
To investigate the relationship between high-sensitivity C-reactive protein and cardiovascular events following acute coronary syndrome.


METHODS
This nationwide, cross-sectional, prospective study involved 439 patients with an acute coronary syndrome who presented to the hospital within 24 hours of symptom onset. Patients with a concomitant inflammatory process were excluded. Predischarge C-reactive protein samples were measured using a high-sensitivity method in a core laboratory. The outcome was the composite of death, acute myocardial infarction, stroke/transient ischemic attack, urgent hospitalization for unstable angina, and urgent revascularization within 1 year.


RESULTS
At 1 year, event rates were 10.2% for the lowest, 8.2% for the middle, and 11.0% for the highest C-reactive protein tertiles (P = .75) with similar event-free survival (P = .70). The hazard ratio (HR) for event rates between the highest and lowest tertiles was 1.10 (95% confidence interval [CI]: 0.54 to 2.20) There was marked overlap of C-reactive protein values between patients with and without events (median [interquartile range]: 8.39 [3.27 to 32.63] vs 9.55 [4.07 to 24.02], respectively; P = .91). C-reactive protein was not an independent predictor of 1-year events (HR for highest tertile: 1.19; 95% CI: 0.58 to 2.43; P = .64) and performed poorly on receiver operating characteristic curve analysis (C statistic = 0.51).


CONCLUSIONS
Predischarge high-sensitivity C-reactive protein level is a poor predictor of cardiovascular events at 1 year after acute coronary syndrome.
Steg
Philippe Gabriel
PG
Department of Cardiology, Hôpital Bichat, Paris, France. gabriel.steg@bch.ap-hop-paris.fr
Ravaud
Philippe
P
Tedgui
Alain
A
Puel
Jacques
J
Moyse
Dominique
D
Curaudeau
Emmanuelle
E
Quentzel
Steven W
SW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000097:blood* / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000378:metabolism; D011237:Predictive Value of Tests; D012307:Risk Factors
D002097:C-Reactive Protein