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.
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY 10029, USA.
Adriano
A
Caixeta
Gregg W
GW
Stone
Roxana
R
Mehran
Edwin A
EA
Lee
Brent T
BT
McLaurin
David A
DA
Cox
Michel E
ME
Bertrand
A Michael
AM
Lincoff
Jeffrey W
JW
Moses
Harvey D
HD
White
E Magnus
EM
Ohman
Tullio
T
Palmerini
George
G
Syros
Christos
C
Kittas
Martin
M
Fahy
W Craig
WC
Hooper
Alexandra J
AJ
Lansky
George D
GD
Dangas
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