C-reactive protein as an independent marker of prognosis in patients with acute coronary syndrome: comparison with cardiac troponin T

Background: It has been suggested that inflammatory processes play a role i n the pathogenesis of acute coronary syndromes (ACS). C-reactive protein (C RP) is a classic acute phase protein. It is yet unclear whether, in additio n to established markers as troponin T (TnT), determination of CRP in patie nts admitted fur ACS contributes significantly to the diagnosis and prognos is of ACS. Patients and Methods: We investigated 50 patients with ACS (59.4 SD 13.9 ye ars) in the first hour after admission and 4-24 h later with respect to TnT (Elecsys(R), Roche Diagnostics) and CRP (biokit, modified Quantex CRP plus , analytical sensitivity 0.02 mg/dL). Fifty percent of the patients were cl assified as having unstable angina retrospectively. All patients were follo wed ill the 6 weeks post discharge regarding death and recurrent ACS. Results: The cumulative event rate at 6 weeks after discharge was 62.5% for patients being CRF and TnT positive compared to 35.3% in TnT positive and CRP negative patients. In TnT negative patients a positive CRP test predict ed 33.3% of events and 28.8% of patients negative for CRP and TnT had event s at 42 days post discharge. Logistic regression analysis regarding the primary endpoint including TnT a nd CRP (4-24 h values), age, gender and diagnosis resulted in independent p rediction of ACS or death by TnT (cutoff 0.1 mu g/L, p=0.048, odds ratio=7. 5) and CRP (cutoff 0.862 mg/dL, p=0.026, odds ratio=5.3). Sensitivity/speci ficity for AMI diagnosis were 69.6%/75% for TnT and 12%/72% for CRP in the first hour and 91.3%/68.2% for TnT and 68%/72% for CRP 4-24 h later. Conclusions: Besides TnT, high sensitivity CRP determination has no additio nal value for early AMI diagnosis. The prognosis of these patients during t he first 24 hours is significantly and independently predicted by CRP measu rements in addition to troponin T.