[Usefulness of troponin I for predicting systolic dysfunction in acute coronary syndromes. Results of a prospective and quantitative study]

[Independent role of C reactive protein to predict major events at one-month and at one-year in acute coronary syndrome without ST elevation]

BACKGROUND AND OBJECTIVE

We intended to determine whether C-reactive protein (CRP) provides independent prognostic information after a non-ST elevation acute coronary syndrome.

PATIENTS AND METHOD

We prospectively studied 630 consecutive patients admitted with a diagnosis of non-ST elevation acute coronary syndrome. Cut-off values were: troponin I > 1 ng/ml (n = 354; 56%) and CRP > 11 mg/l (n = 273; 43%).

RESULTS

Within a one-year follow-up period, 56 (9%) cardiac deaths, 85 (13%) myocardial infarctions (MI) and 127 (20%) first major events were detected. Patients with increased CRP showed higher rates of death at one-month (8% vs 1%), death at one-year (15% vs 4%), myocardial infarction at one-month (8% vs 4%), myocardial infarction at one-year (19% vs 9%), major events at one-month (15% vs 5%) and major events at one-year (30% vs 13%). In the multivariate analysis, once adjusted for baseline and electrocardiogram data and for myocardial damage markers, CRP was an independent predictor of death at one-month (odds ratio [OR] 4.6) and death at one-year (OR = 2.7), major events at one-month (OR = 1.8) and major events at one-year (OR = 1.8). Troponin I predicted MI at one-month (OR = 2.5) and MI at one-year (OR = 2.2).

CONCLUSIONS

CRP provided independent information to predict major events in non-ST elevation acute coronary syndromes. Troponin I was a more powerful predictor of MI than PCR. The analysis of CRP and myocardial damage markers in the short-term and long-term risk stratification seems worthy.