Independent prognostic value of elevated C-reactive protein in unstable angina

Background-There is growing evidence of the prognostic importance of C-reac tive protein (CRP) in unstable angina. However, the independent value of CR P relative to other conventional markers at different stages of treatment h as not been established. Therefore, we assessed the in-hospital and 90-day prognostic values of serum CRP in unstable angina. We also compared the rel ation of CRP at admission and discharge with 90-day outcome. Methods and Results-One hundred ninety-four consecutive patients were inclu ded in a derivation (n = 105) and a validation set (n = 89). Serum CRP was measured at admission, at 48 hours, and at hospital discharge. A cutoff poi nt of 1.5 mg/dL for CRP provided optimum sensitivity and specificity for ad verse outcome, based on the receiver operator curves. No association was fo und between CRP on admission and in-hospital outcome. CRP at admission, adj usted for age, ECG findings on admission, silent ischemia, left ventricular wall motion score, and high-risk clinical presentation, was related to the combined end point of refractory angina, myocardial infarction, or death a t 90 days (hazard ratio [HR] 1.9, 95% CI 1.2 to 8.3, P = 0.002). CRP at hos pital discharge was the strongest independent marker of an adverse outcome (HR 3.16, 95% CI 2.0 to 5.2, P = 0.0001). These results were confirmed in t he validation set (CRP at discharge: HR 3.3, 95% CI 2.0 to 7.69, P = 0.0001 ). Conclusions-In unstable angina, CRP is a strong independent marker of incre ased 90-day risk. Compared with CRP at. admission, CRP at discharge is bett er related to later outcome and could be of great utility for risk stratifi cation.