title: Predicting outcomes in acute coronary syndrome using biochemical markers.
abstract: OBJECTIVE
  To assess risk prediction in patients with acute coronary syndrome (ACS) during the hospital stay, at 6 weeks and at 6 months period using high sensitivity C-reactive protein (hs-CRP), serum creatinine, cardiac troponin I, creatine kinase total, and MB levels.
  
  
  METHODS
  It was a prospective observational study. The primary outcome was taken as all-cause mortality. Patients with ACS were enrolled and followed up at 6 weeks and 6 months duration from the index event. Mortality and cause of death were recorded. The hs-CRP was estimated on admission, at 6 weeks, and at 6 months. The estimated glomerular filtration rate (eGFR) was calculated using the abbreviated modification of diet in renal disease (MDRD) formula at admission, at 6 weeks, and 6 months.
  
  
  RESULTS
  There were a total of 108 cases of ACS in the duration of 6 months who completed the follow-up. The hs-CRP level of >5mg/dl was highly significant for predicting mortality during hospital stay and at 6 weeks (p<0.001). There was 11% of in-hospital mortality (p<0.001). At 6 months, the overall mortality was 28% (p<0.001). There was a statistical significance with low eGFR (median eGFR 45ml/min/1.73m(2)) levels during the admission.
  
  
  CONCLUSIONS
  hs-CRP levels above 5mg/dl and the eGFR levels ≤30ml/min/1.73m(2) were significant in predicting mortality of the patients with ACS. This may provide simple assessment tools for predicting outcome in ACS in resource-poor settings if validated further.
authors.affiliation: Prof & Head, Department of Internal Medicine & Chair, Cardiology Division, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. Electronic address: prahladkarki@hotmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Karki
authors.affiliation: Senior Resident, Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: K K
authors.initials: KK
authors.lastname: Agrawaal
authors.affiliation: Professor, Department of Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: M
authors.initials: M
authors.lastname: Lamsal
authors.affiliation: Associate Professor, Department of Internal Medicine & Cardiology Division, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
authors.forename: N R
authors.initials: NR
authors.lastname: Shrestha
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000401:mortality; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000378:metabolism; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D019210:Troponin I / Q000097:blood
chemical_list: D015415:Biomarkers; D019210:Troponin I; D002097:C-Reactive Protein
keywords: Acute coronary syndrome; Biochemical markers; Estimated glomerular filtration rate (eGFR); High sensitivity C-reactive protein (hs-CRP); Predicting outcome