Abstract 3776: White Elephant or Useful Tool? Incremental Prognostic Value of C-reactive Protein in Patients with Acute Coronary Syndromes. The GRACE registry
Background: Elevated C-reactive protein (CRP) levels have been associated with adverse outcome in patients with acute coronary syndromes. It is not clear, however, if CRP adds clinically relevant incremental value to standard risk scores.
Methods: We evaluated in-hospital and 6-month outcomes of 5,667 patients with baseline CRP data who were enrolled in the GRACE registry. Patients were divided into CRP tertiles (<3.6, 3.6 –9.9, >9.9 mg/dL). A logistic regression model was used to assess the incremental prognostic value of CRP added to the GRACE score for predicting in-hospital death.
Results: Patients in the third tertile of CRP were older, more likely to be female, have a history of diabetes, and a worse Killip class at presentation. They were slightly less likely to be treated with an invasive approach or to undergo revascularization. In-house complications such as recurrent ischemia, pulmonary edema, cardiogenic shock, renal failure, and major bleeding were more common among patients in the third tertile. The incidence of in-hospital death (tertile 1, 2.2%; tertile 2, 2.2%; tertile 3, 8.5%) and 6-month mortality among patients surviving to discharge (tertile 1, 1.9%; tertile 2, 3.1%; tertile 3, 6.8%) was also highest in the third tertile. Compared to tertile 1, tertile 3 was an independent marker of in-hospital mortality after adjusting for the GRACE risk score (OR 2.12, 95% CI 1.39 –3.23; P=0.001). Incorporation of CRP tertiles only marginally improved the c statistic for the GRACE risk score model from 0.86 to 0.87.
Conclusion: Elevated CRP level is an independent predictor of mortality in patients with acute coronary syndromes. However, it provides minimal incremental value beyond that provided by standard risk scores.