Elevated C-Reactive Protein at Discharge is a Strong Independent Predictor of 90 Day Outcome in Unstable Angina

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Abstract

Objective

To determine the prognostic value of C-reactive protein for ischemic events during in-hospital period and at 90 days in patients admitted with unstable angina and without prior myocardial infarction nor total CK elevation post-admission.

Methods

Two population sets were prospectively enrolled (105 patients: derivation set, 89 patients: validation set). Measurement of C-reactive protein was performed at admission, 48 hours and at hospital discharge. A 90 day follow-up was conducted to de-termine the occurrence of a primary combined endpoint (death and/or acute myocardial infarction and/or refractory angina).

Results

The best area of the ROC curves of the C-reactive protein measurements for prediction of events at90 days was 0.84 (SE 0.054) corresponding to theC-reactive protein determined at discharge (LR for a cut-off point of 1.5 mg/dl of5.6).In a Cox regression model for predicting the primary end point at 90 days applied to both population sets, which included age, ST segment depression, and silent ischemia the strongest independent predictor wasC-reactive at discharge > 1.5 mg/dl. C-reactive protein at admission was not predictive of adverse in-hospital outcome.

Conclusion

In unstable angina, a high proportion of patients have persistent inflammatory activity despite intensive medical treatment and waning of symptoms. This finding is associated to an adverse 90-day prognosis and could be used as an independent criterion to identify a group of high risk patients.