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Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes?
Clin Chim Acta. 2007 Jan; 375(1-2):124-8.CC

Abstract

BACKGROUND

C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score.

METHODS

Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score.

RESULTS

A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, p<0.001). The additional value of the new score is demonstrated by a higher specificity (86% vs. 63%, p<0.001) and positive predictive value (39% vs. 19%) in relation to the TIMI-Risk Score.

CONCLUSIONS

CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification.

Authors+Show Affiliations

Medical School of Bahia, Scientific Development Foundation, Salvador-Bahia, Brazil. lccorreia@terra.com.brNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16916502

Citation

Correia, Luis C L., et al. "Does High-sensitivity C-reactive Protein Add Prognostic Value to the TIMI-Risk Score in Individuals With non-ST Elevation Acute Coronary Syndromes?" Clinica Chimica Acta; International Journal of Clinical Chemistry, vol. 375, no. 1-2, 2007, pp. 124-8.
Correia LC, Lima JC, Rocha MS, et al. Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes? Clin Chim Acta. 2007;375(1-2):124-8.
Correia, L. C., Lima, J. C., Rocha, M. S., D'Oliveira Junior, A., & Péricles Esteves, J. (2007). Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes? Clinica Chimica Acta; International Journal of Clinical Chemistry, 375(1-2), 124-8.
Correia LC, et al. Does High-sensitivity C-reactive Protein Add Prognostic Value to the TIMI-Risk Score in Individuals With non-ST Elevation Acute Coronary Syndromes. Clin Chim Acta. 2007;375(1-2):124-8. PubMed PMID: 16916502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does high-sensitivity C-reactive protein add prognostic value to the TIMI-Risk Score in individuals with non-ST elevation acute coronary syndromes? AU - Correia,Luis C L, AU - Lima,José C, AU - Rocha,Mário S, AU - D'Oliveira Junior,Argemiro, AU - Péricles Esteves,J, Y1 - 2006/06/29/ PY - 2006/01/28/received PY - 2006/06/23/revised PY - 2006/06/26/accepted PY - 2006/8/19/pubmed PY - 2007/2/3/medline PY - 2006/8/19/entrez SP - 124 EP - 8 JF - Clinica chimica acta; international journal of clinical chemistry JO - Clin Chim Acta VL - 375 IS - 1-2 N2 - BACKGROUND: C-reactive protein (CRP) measured at hospital arrival of patients with non-ST elevation acute coronary syndromes (ACS) may add prognostic information to the TIMI-Risk Score. METHODS: Eighty-six consecutive patients admitted with unstable angina or non-ST-elevation acute myocardial infarction and symptoms onset within the prior 48 h were included. Recurrent cardiovascular events during hospitalization were defined as non-fatal myocardial infarction or death. Serum CRP was measured immediately at hospital arrival and its prognostic value in relation to in-hospital cardiovascular events was tested by the area under the ROC curve and adjusted for TIMI risk predictors by logistic regression analysis. In addition, a CRP modified TIMI-Risk score was created by adding 2 points if CRP greater than the cut-off proposed by the ROC curve analysis. The accuracy of this new score was compared with the usual TIMI-Risk Score. RESULTS: A significant predictive value of CRP in relation to in-hospital cardiovascular events was indicated by an area under the ROC curve of 0.80 (95% CI=0.66 to 0.93, p=0.009). C-reactive protein cut-off point of best prognostic performance was 7.2 mg/l. In the multivariate analysis, increased CRP (>7.2 mg/l) remained a significant predictor of events after adjustment for TIMI risk predictors (OR=14; 95% CI=1.6-121; p=0.018). The area under the ROC curve for the TIMI-Risk Score was 0.87 (95% CI=0.76-0.99, p=0.001). The addition of CRP to the TIMI-Risk Score improved its prognostic value (area under the ROC curve=0.93; 95% CI=0.87-0.99, p<0.001). The additional value of the new score is demonstrated by a higher specificity (86% vs. 63%, p<0.001) and positive predictive value (39% vs. 19%) in relation to the TIMI-Risk Score. CONCLUSIONS: CRP measured at admission of patients with non-ST-elevation acute coronary syndromes adds prognostic information to the TIMI-Risk Score. Additionally, the incorporation of this variable into the TIMI-Risk Score calculation is an effective manner to utilize CRP for risk stratification. SN - 0009-8981 UR - https://www.unboundmedicine.com/medline/citation/16916502/Does_high_sensitivity_C_reactive_protein_add_prognostic_value_to_the_TIMI_Risk_Score_in_individuals_with_non_ST_elevation_acute_coronary_syndromes L2 - https://linkinghub.elsevier.com/retrieve/pii/S0009-8981(06)00402-5 DB - PRIME DP - Unbound Medicine ER -