Does C-reactive protein add prognostic value to GRACE score in acute coronary syndromes?
BACKGROUND
The incremental prognostic value of plasma levels of C-reactive protein (CRP) in relation to GRACE score has not been established in patients with acute coronary syndrome (ACS) with non-ST segment elevation.


OBJECTIVE
To test the hypothesis that CRP measurements at admission increases the prognostic value of GRACE score in patients with ACS.


METHODS
A total of 290 subjects, consecutively admitted for ACS, with plasma material obtained upon admission CRP measurement using a high-sensitivity method (nephelometry) were studied. Cardiovascular outcomes during hospitalization were defined by the combination of death, nonfatal myocardial infarction or nonfatal refractory angina.


RESULTS
The incidence of cardiovascular events during hospitalization was 15% (18 deaths, 11 myocardial infarctions, 13 angina episodes) with CRP showing C-statistics of 0.60 (95% CI = 0.51-0.70, p = 0.034) in predicting these outcomes. After adjustment for the GRACE score, elevated CRP (defined as the best cutoff point) tended to be associated with hospital events (OR = 1.89, 95% CI = 0.92 to 3.88, p = 0.08). However, the addition of the variable elevated CRP in the GRACE model did not result in significant increase in C-statistics, which ranged from 0.705 to 0.718 (p = 0.46). Similarly, there was no significant reclassification of risk with the addition of CRP in the predictor model (net reclassification = 5.7 %, p = 0.15).


CONCLUSIONS
Although CRP is associated with hospital outcomes, this inflammatory marker does not increase the prognostic value of the GRACE score.
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Luis Cláudio Lemos
LC
Correia
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Isis
I
Vasconcelos
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Guilherme
G
Garcia
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Felipe
F
Kalil
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Felipe
F
Ferreira
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
André
A
Silva
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Ruan
R
Oliveira
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Manuela
M
Carvalhal
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Caio
C
Freitas
Escola Bahiana de Medicina e Saúde Pública, Salvador, BA, Brasil.
Márcia Maria
MM
Noya-Rabelo
D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012680:Sensitivity and Specificity
D015415:Biomarkers; D002097:C-Reactive Protein