M. Mockel et al., C-reactive protein as an independent marker of prognosis in patients with acute coronary syndrome: comparison with cardiac troponin T, Z KARDIOL, 89(8), 2000, pp. 658-666
Citations number
31
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
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.