title: High-sensitivity C-reactive protein predicts adverse outcomes after non-ST-segment elevation acute coronary syndrome regardless of GRACE risk score, but not after ST-segment elevation myocardial infarction.
abstract: BACKGROUND
  Atherosclerosis is an active process and the inflammatory component appears to be particularly correlated with the development of acute coronary syndromes (ACS). C-reactive protein (CRP) is an acute phase protein that appears in the circulation in response to inflammatory cytokines. The present study investigated the association between high-sensitivity C-reactive protein (hsCRP) on admission and follow-up prognosis after an ACS.
  
  
  METHODS
  We included 151 consecutive patients admitted to the coronary care unit with a diagnosis of ACS (47% ST-segment elevation myocardial infarction [STEMI]). The primary endpoint was the combination of cardiac death and myocardial reinfarction during the follow-up period (median 19.8 months, interquartile range 16.3-23.7 months).
  
  
  RESULTS
  The occurrence of follow-up events was significantly related to admission hsCRP level, which was an excellent predictor of cardiac death and reinfarction during follow-up (HR 1.091, 95% CI 1.014-1.174; p=0.019). Stratifying the population based on type of ACS, adjusted by variables associated with cardiac events in univariate analysis (hsCRP, diabetes, depressed ejection fraction and GRACE risk score), hsCRP proved to be an independent predictor of follow-up outcomes only in non-STEMI patients (HR 1.217, 95% CI: 1.093-1.356, p<0.001), not in STEMI patients. The best cutoff level of hsCRP to predict follow-up outcomes was 1.1mg/dl, with sensitivity of 77.8% and specificity of 63.2%.
  
  
  CONCLUSIONS
  Although the GRACE risk score is routinely used for stratification of patients with ACS, assessment of hsCRP may provide additional prognostic value in the follow-up of non-STEMI patients.
authors: Department of Cardiology, University Clinical Hospital of Santiago de Compostela, A Coruña, Spain. raposeiras26@hotmail.com
authors: Sergio
authors: S
authors: Raposeiras Roubín
authors: Cristina
authors: C
authors: Barreiro Pardal
authors: Filomena
authors: F
authors: Roubín-Camiña
authors: Raymundo
authors: R
authors: Ocaranza Sanchez
authors: Ezequiel
authors: E
authors: Alvarez Castro
authors: Beatriz
authors: B
authors: Paradela Dobarro
authors: Jose María
authors: JM
authors: García-Acuña
authors: Pablo
authors: P
authors: Aguiar Souto
authors: Michel
authors: M
authors: Jacquet Hervet
authors: Maria José
authors: MJ
authors: Castromán
authors: Isabel
authors: I
authors: Arufe
authors: Belén
authors: B
authors: Outes
authors: María Victoria
authors: MV
authors: Reino-Maceiras
authors: Emad
authors: E
authors: Abu Assi
authors: José Ramón
authors: JR
authors: González-Juanatey
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
chemical_list: D002097:C-Reactive Protein