Predictive value of C-reactive protein on 30-day and 1-year mortality in acute coronary syndromes: an analysis from the ACUITY trial.
We sought to evaluate the association between C-reactive protein (CRP) sampled on admission and short- and long-term mortality in patients with acute coronary syndromes (ACS) undergoing early invasive treatment. Baseline levels of CRP were determined in 2,974 patients with moderate and high-risk ACS undergoing an early invasive treatment strategy in the large-scale randomized ACUITY trial. The relationship of CRP to 30-day and 1-year clinical outcomes were assessed according to quartiles of CRP values. Patients with CRP levels in the fourth quartile compared to the first quartile had significantly higher 30-day mortality (2.3 vs. 0.3%, P = 0.0004) and 1-year mortality (5.5 vs. 2.8%, P = 0.0003). CRP level as a continuous variable was associated with 30-day mortality (OR [95% CI] for one unit increase in logarithmically transformed CRP level = 1.42 [1.08-1.89], P = 0.01) and 1-year mortality (OR [95% CI] = 1.24, [1.04-1.47], P = 0.02). By multivariable analysis, higher baseline CRP levels independently predicted 30-day and 1-year mortality, a relationship that was particularly strong for patients with the highest quartile of CRP (OR [95% CI] = 5.19 [1.14-23.68], P = 0.009). In troponin-positive patients, increasing quartiles of CRP were associated with a trend for 30-day mortality (P (trend) = 0.08) and a significant increase in 1-year mortality (P (trend) = 0.02); this relationship was not present in troponin-negative patients. Baseline CRP level is a powerful independent predictor of both early and late mortality in patients with ACS being treated with an early invasive strategy, especially in troponin positive patients.
Caixeta
Adriano
A
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10029, USA.
Stone
Gregg W
GW
Mehran
Roxana
R
Lee
Edwin A
EA
McLaurin
Brent T
BT
Cox
David A
DA
Bertrand
Michel E
ME
Lincoff
A Michael
AM
Moses
Jeffrey W
JW
White
Harvey D
HD
Ohman
E Magnus
EM
Palmerini
Tullio
T
Syros
George
G
Kittas
Christos
C
Fahy
Martin
M
Hooper
W Craig
WC
Lansky
Alexandra J
AJ
Dangas
George D
GD
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality* / Q000628:therapy*; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors
D002097:C-Reactive Protein