Key result
Elevated admission C-reactive protein (≥10 mg/L) in patients with unstable angina was associated with a significantly higher rate of in-hospital cardiac events compared to normal levels (86% vs 24%, p<0.0001).
Why the study?
Does elevated admission C-reactive protein predict in-hospital cardiac events and severe coronary artery disease in patients with unstable angina?
Observational (n=100)
No
Does elevated admission C-reactive protein predict in-hospital cardiac events and severe coronary artery disease in patients with unstable angina?
Absolute Event Rate: 86% vs 24%
p-value: p=<0.0001
Elevated admission CRP (≥10 mg/l) in patients with unstable angina and negative troponin is a strong predictor of in-hospital cardiac events and severe coronary artery disease, aiding in early risk stratification.
May support CRP for risk stratification in unstable angina; leaves open prospective validation before practice change.
OBJECTIVE: To assess prevalence, in-hospital prognostic significance and angiographic correlation of C-reactive protein (CRP) elevation in patients with unstable angina. DESIGN: Prospective observational study. SETTING: Royal Hospital, Muscat, Oman. PATIENTS: 100 patients admitted between July 2008 and January 2009. INTERVENTIONS: Patients with unstable angina and ECG changes without biochemical evidence of necrosis (negative first troponin T), had CRP measured at admission by rate nephelometry (≥10 mg/l abnormal). MAIN OUTCOME MEASURES: In-hospital cardiac events and severity of coronary artery disease (CAD) in patients with and without CRP elevation. RESULTS: 42% had CRP elevation ≥10 mg/l (Group I), and 58% had levels <10 mg/l (Group II). When compared with Group II, Group I patients had more anginal episodes (mean=4.6±2.5 episodes/patient vs 1.6±2.4; p<0.0001), myocardial infarction (58% vs 17%; p<0.01), in-hospital mortality (9% vs 0%; p=0.03) and severe triple vessel disease (71% vs 24%; p<0.01), and a higher total number of events (86% vs 24%; p<0.0001). Elevated admission CRP as a marker of in-hospital cardiac events showed a sensitivity of 72%, specificity of 88% and positive predictive value of 85%, and, as a marker of significant CAD, showed a specificity of 83% and a positive predictive value of 85%. CONCLUSIONS: Raised admission CRP level is predictive of increased in-hospital cardiac events and severe CAD in patients with unstable angina. CRP can be used to risk-stratify unstable angina patients independent of troponin levels. Patients with abnormal CRP should undergo coronary angiography either on-site or transferred to a centre with catheterisation facility during the index hospital admission.
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Panduranga et al. (2010) conducted an observational in Unstable angina (n=100). Elevated C-reactive protein (≥10 mg/L) vs. Normal C-reactive protein (<10 mg/L) was evaluated on Total in-hospital cardiac events (recurrent angina, non-STEMI, death, urgent revascularization) (p=<0.0001). Elevated admission C-reactive protein (≥10 mg/L) in patients with unstable angina was associated with a significantly higher rate of in-hospital cardiac events compared to normal levels (86% vs 24%, p<0.0001).
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