C-reactive protein in unstable angina: clinical and angiographic correlation.
OBJECTIVE
To assess prevalence, in-hospital prognostic significance and angiographic correlation of C-reactive protein (CRP) elevation in patients with unstable angina.


METHODS
Prospective observational study.


METHODS
Royal Hospital, Muscat, Oman.


METHODS
100 patients admitted between July 2008 and January 2009.


METHODS
Patients with unstable angina and ECG changes without biochemical evidence of necrosis (negative first troponin T), had CRP measured at admission by rate nephelometry (≥10 mg/l abnormal).


METHODS
In-hospital cardiac events and severity of coronary artery disease (CAD) in patients with and without CRP elevation.


RESULTS
42% had CRP elevation ≥10 mg/l (Group I), and 58% had levels <10 mg/l (Group II). When compared with Group II, Group I patients had more anginal episodes (mean=4.6±2.5 episodes/patient vs 1.6±2.4; p<0.0001), myocardial infarction (58% vs 17%; p<0.01), in-hospital mortality (9% vs 0%; p=0.03) and severe triple vessel disease (71% vs 24%; p<0.01), and a higher total number of events (86% vs 24%; p<0.0001). Elevated admission CRP as a marker of in-hospital cardiac events showed a sensitivity of 72%, specificity of 88% and positive predictive value of 85%, and, as a marker of significant CAD, showed a specificity of 83% and a positive predictive value of 85%.


CONCLUSIONS
Raised admission CRP level is predictive of increased in-hospital cardiac events and severe CAD in patients with unstable angina. CRP can be used to risk-stratify unstable angina patients independent of troponin levels. Patients with abnormal CRP should undergo coronary angiography either on-site or transferred to a centre with catheterisation facility during the index hospital admission.
Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Prashanth
P
Panduranga
Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Abdulla A
AA
Riyami
Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Kadhim J
KJ
Sulaiman
Department of Cardiology, Royal Hospital, Muscat, Sultanate of Oman.
Mohammed
M
Mukhaini
Angina; angina—unstable; coronary angiography; coronary artery disease; coronary artery diseaseinflammation; inflammation; unstablecoronary angiography