Elevated hsCRP >3 mg/L at 30 days post-acute coronary syndrome was associated with a higher risk of 2-year mortality compared to hsCRP <1 mg/L (HR 3.7; 95% CI 1.9-7.2; P<0.0001).
RCT (n=3,813)
randomly assigned
Do achieved hsCRP levels at 30 days and 4 months predict long-term survival in patients with acute coronary syndrome, and does intensive statin therapy improve hsCRP reduction?
Achieved hsCRP levels at 30 days and 4 months post-ACS are independently associated with long-term survival, and intensive statin therapy increases the likelihood of achieving lower hsCRP levels.
Effect estimate: HR 3.7 (95% CI 1.9 to 7.2)
Absolute Event Rate: 6.1% vs 1.6%
p-value: p=<0.0001
BACKGROUND: Elevated levels of high-sensitivity C-reactive protein (hsCRP) are associated with higher risk of adverse outcomes in patients at risk for or with established coronary artery disease. Retrospective analyses suggest that this risk may be modified with statin therapy. However, a role for hsCRP in monitoring the success of therapy remains uncertain. METHODS AND RESULTS: We measured the serum concentration of hsCRP at 30 days (n=3813) and 4 months in patients with non-ST-elevation or ST-elevation acute coronary syndrome randomly assigned to an early intensive versus delayed conservative simvastatin strategy in the Aggrastat-to-Zocor Trial. Patients with hsCRP >3 mg/L at 30 days had significantly higher 2-year mortality rates than those with hsCRP 1 to 3 mg/L or hsCRP 3 mg/L were at more than 3-fold higher risk of death (HR, 3.7; 95% CI, 1.9 to 7.2) compared with those with hsCRP <1 mg/L. "Average" levels of hsCRP (1 to 3 mg/L) were also associated with increased risk compared with those with hsCRP <1 mg/L (HR, 2.3; 95% CI, 1.2 to 4.6). Patients allocated to early intensive statin therapy were more likely to achieve hsCRP levels <1 mg/L at 30 days (P=0.028) and 4 months (P<0.0001). CONCLUSIONS: Achieved levels of hsCRP at 30 days and 4 months after acute coronary syndrome are independently associated with long-term survival. Patients treated with more aggressive statin therapy are more likely to achieve lower levels of hsCRP.
Morrow et al. (Tue,) conducted a rct in non-ST-elevation or ST-elevation acute coronary syndrome (n=3,813). hsCRP >3 mg/L vs. hsCRP <1 mg/L was evaluated on 2-year mortality (HR 3.7, 95% CI 1.9 to 7.2, p=<0.0001). Elevated hsCRP >3 mg/L at 30 days post-acute coronary syndrome was associated with a higher risk of 2-year mortality compared to hsCRP <1 mg/L (HR 3.7; 95% CI 1.9-7.2; P<0.0001).