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Clinical application of C-reactive protein across the spectrum of acute coronary syndromes . BACKGROUND High-sensitivity C-reactive protein ( hsCRP ) is associated with adverse cardiovascular outcomes in acute coronary syndromes ( ACS ) . The ability to formulate recommendations regarding clinical use of hsCRP is limited by a paucity of data regarding several key issues . The purpose of this study was to evaluate hsCRP across the spectrum of ACS . METHODS hsCRP was measured on admission in 3225 patients with ACS . hsCRP concentrations were compared in patients who suffered an adverse cardiac outcome within 10 months of study entry and in patients who had no adverse event . Because of heterogeneity in the relationship between hsCRP and clinical outcomes , evaluation was limited to patients from whom samples were collected within 48 h of symptom onset . RESULTS Patients in the highest quartile of hsCRP compared to those in the lowest quartile were at increased risk of death at 30 days [ adjusted hazard ratio ( adjHR ) 4.6 , P < 0.001 ] and 10 months ( adjHR 3.9 , P < 0.001 ) . In patients with unstable angina/non-ST-elevation myocardial infarction ( STEMI ) , hsCRP > 3 mg/L was associated with increased 10-month mortality ( adjHR 2.3 , P = 0.002 ) , whereas in STEMI a relationship with mortality was seen at hsCRP > 10 mg/L ( adjHR 3.0 , P = 0.008 ) . Increased concentrations of hsCRP were strongly associated with the development of heart failure at 30 days ( adjHR 8.2 , P = 0.001 ) and 10 months ( adjHR 2.6 , P = 0.014 ) . CONCLUSION Increased baseline concentrations of hsCRP are strongly associated with mortality and heart failure across the ACS spectrum . hsCRP measurement should be performed early after presentation and index diagnosis-specific cutpoints should be used .
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Intervention_Physical
C-reactive protein
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Intervention_Pharmacological
High-sensitivity C-reactive protein ( hsCRP )
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Intervention_Pharmacological
hsCRP
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Outcome_Physical
hsCRP
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Outcome_Physical
hsCRP concentrations
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Outcome_Mortality
risk of death
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Outcome_Physical
hsCRP
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Outcome_Physical
heart failure
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Outcome_Physical
baseline concentrations of hsCRP
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Outcome_Mortality
mortality
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Outcome_Physical
heart failure