Serum amyloid A is a better predictor of clinical outcomes than C-reactive protein in non-ST-segment elevation acute coronary syndromes.
BACKGROUND
Elevated C-reactive protein (CRP) is associated with adverse outcomes in non-ST-segment elevation acute coronary syndromes (NSTE-ACS); however, the prognostic significance of serum amyloid A (SAA), also an important inflammatory marker, remains unclear.


RESULTS
The ability of SAA, in combination with CRP, to predict clinical outcomes was evaluated in 277 patients with NSTE-ACS. Patients were classified according to the presence or absence of elevated SAA (>0.8 mg/dl) and elevated high-sensitivity CRP (>0.200 mg/dl) on admission: group 1, both SAA and CRP normal (n=133); group 2, SAA normal, but CRP elevated (n=30); group 3, SAA elevated, but CRP normal (n=28); and group 4, both SAA and CRP elevated (n=86). In groups 1, 2, 3, and 4, the rates of combined endpoints including death, (re)infarction, or urgent target-vessel revascularization at 30 days were 8%, 3%, 25%, and 23%, respectively (p=0.002). Multivariate analysis showed that as compared with group 1, the odds ratios for combined endpoints in groups 2, 3, and 4 were 0.50 (p=0.30), 1.95 (p=0.038), and 1.86 (p=0.044), respectively.


CONCLUSIONS
Regardless of the level of CRP, elevated SAA is associated with adverse 30-day outcomes in patients with NSTE-ACS, so SAA is a better predictor of clinical outcome than CRP in these patients.
Kosuge
Masami
M
Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan.
Ebina
Toshiaki
T
Ishikawa
Toshiyuki
T
Hibi
Kiyoshi
K
Tsukahara
Kengo
K
Okuda
Jyun
J
Iwahashi
Noriaki
N
Ozaki
Hiroyuki
H
Yano
Hideto
H
Kusama
Ikuyoshi
I
Nakati
Tastuya
T
Umemura
Satoshi
S
Kimura
Kazuo
K
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000097:blood* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D011237:Predictive Value of Tests; D011379:Prognosis; D000685:Serum Amyloid A Protein / Q000032:analysis / Q000378:metabolism*
D015415:Biomarkers; D000685:Serum Amyloid A Protein; D002097:C-Reactive Protein