PROGNOSTIC INFLUENCE OF INCREASED FIBRINOGEN AND C-REACTIVE PROTEIN-LEVELS IN UNSTABLE CORONARY-ARTERY DISEASE

Background The prognostic influences of fibrinogen and C-reactive prot ein levels and their-relations to myocardial damage in unstable corona ry artery syndromes have not been well described. Methods and Results Fibrinogen and C-reactive protein were determined at inclusion and rel ated to outcome after 5 months in 965 patients with unstable angina or non-Q-wave myocardial infarction randomized to 5 weeks with low-molec ular-weight heparin or placebo, The probabilities of death were 1.6%, 4.6%, and 6.9% (P=.005) and the probabilities of death and/or myocardi al infarction were 9.3%, 14.2%, and 19.1% (P=.002), respectively, in p atients stratified by tertiles of fibrinogen (<3.35, 3.38 to 3.99, and greater than or equal to 4.0 g/L). The probabilities of death were 2. 2%, 3.6%, and 7.5% (P=.003) after stratification of patient data by te rtiles of C-reactive protein level (<2, 2 to 10, and >10 mg/L). In log istic multiple regression analysis, increased fibrinogen levels were i ndependently associated with the incidence of death and/or myocardial infarction (P=.013), and elevated C-reactive protein level was associa ted with the incidence of death (P=.012). The increased relative risk of subsequent death or myocardial infarction in individuals with an el evated fibrinogen level was consistent in most subgroups evaluated; al though significantly so only in patients with signs of myocardial dama ge. Conclusions Increased levels of both fibrinogen and C-reactive pro tein are associated with a worse outcome in patients with unstable cor onary artery disease. The increased risk associated with elevated fibr inogen levels is independent of, and additive to, the prognostic influ ence of myocardial damage.