HS– C– Reactive Protien (HS–CRP): A Dependable  Prognostic Marker in Acute Coronary Syndromes.

SN Mahajan; Ajay Jain; Sourya Acharya; SK Diwan

Volume : III, Issue : VII, July - 2013

HS– C– Reactive Protien (HS–CRP): A Dependable Prognostic Marker in Acute Coronary Syndromes.

Sn Mahajan, Ajay Jain , Sourya Acharya, Sk Diwan

Abstract :

Aims and Objectives: To determine the prognostic value of serum C–Reactive Protein (CRP) in patients of Acute Coronary Syndromes. To compare the prognostic value of C–Reactive Protein (CRP) with the other known prognostic variables for Acute Coronary Syndromes. Methods: All the patients were evaluated with a detailed history and clinical examination. The relevant past history profile, Coronary artery disease (CAD) risk factors, drug and treatment history were noted. In addition, all the patients were subjected to a detailed general and systemic physical examination, with particular reference to the presence of any complications of CAD (e.g. CHF, hypotension, pulmonary edema) and any signs of a systemic illness. The cases were divided into 2 groups. Group 1 consisted of patients with Acute MI and group 2 consisted patients with unstable angina. All the base line investigations including ECG and 2D ECHO evaluation were done. C–reactive protein (CRP) estimation – CRP estimation was done once at the time of admission in all the patients using a high sensitivity Microwell (solid phase) enzyme–linked immunosorbent assay: HS–CRP ELISA. All patients were assessed for the adverse outcome measures like reperfusion failure , Recurrent angina ,non fatal myocardial infarction, serious arrhythmias, cardiogenic shock, cardiac death, left ventricular dysfunction on 2–D echocardiography, and congestive heart failure. Statistical analysis was done using the following tests where applicable: analysis of variance (ANOVA), Students t–test, Fishers exact test and chi–square (x2) test. The statistical significance was evaluated by calculating the P value. The difference was considered significant when the P value was < 0.05 (one in twenty). The prognostic value of CRP for prediction of an adverse outcome was defined in terms of statistical parameters (i.e. sensitivity, specificity, positive predictive value, negative predictive value and relative risk) and was compared with those of other known prognostic variables. Results: 40.0% of the study population had a CRP value > 8 mg/L. The mean CRP level (ELISA method) in our study was 9.8 ± 5.22 mg/L. The mean CRP values in group I (AMI) and group II (Unstable Angina) patients were 9.8 ± 6.08 mg/L, and 9.7 ± 4.36 mg/L, respectively. , those group I patients who had reperfusion failure or recurrent angina, had a significantly higher level of CRP than those who did not have them (P < 0.01 and = 0.04, respectively). Group II patients who had recurrent angina or LV dysfunction on 2–D echo; LVEF < 40%, had a significantly higher level of CRP than those who did not have them (P = 0.01 and 0.05, respectively). , there is a statistically significant correlation between reperfusion failure or recurrent angina as adverse outcomes, and CRP (ELISA) level > 8 mg/L in group I (AMI) patients (P < 0.01 and = 0.03, respectively), there is a statistically significant correlation between recurrent angina or LV dysfunction on 2–D echo; LVEF < 40% as adverse outcomes, and CRP (ELISA) level > 8 mg/L in group II (UA) patients (P = 0.03 and 0.02,respectively). Conclusion: The present study demonstrates that C–reactive protein (CRP) has an independent prognostic significance in the patients of acute coronary syndromes, as the value of CRP > 8 mg/L, on admission [quantitative estimation by high sensitivity Microwell (solid phase) ELISA method] correlates well with an increased overall risk of adverse cardiac outcome during the short term follow up. an elevated serum CRP level (CRP > 8 mg/L) on hospital admission is predictive of an increased risk of recurrent angina and left ventricular dysfunction in the patients of unstable angina.