A Comparative Study of the C-Reactive Protein and the ST-Score (ECG) as Prognostic Indicators in Acute Myocardial Infarction in a Rural Resource-Constrained Hospital Setting in Central India: A Cross-Sectional Study.
BACKGROUND
The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events.


OBJECTIVE
The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India.


METHODS
Cross sectional study, rural hospital in central India.


METHODS
In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission.


METHODS
We used Student's t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals.


RESULTS
STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively.


CONCLUSIONS
STS on admission is independent predictor while hs- CRP is not in resource constrained settings.
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
Jyoti
J
Jain
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
Udit Ravinder
UR
Narang
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
Vishakha Vinay
VV
Jain
Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra, India.
Om P
OP
Gupta
Acute ST elevated myocardial infarction; ST-Score; electrocardiogram; hs-CRP; prognostic indicator