Revista argentina de cardiología
versión On-line ISSN 1850-3748
NAVARRO ESTRADA, José L et al. Prognostic Value of C-reactive Protein and Troponin I C in Patients with Chest Pain. Rev. argent. cardiol. [online]. 2005, vol.73, n.6, pp. 416-423. ISSN 1850-3748.
Introduction and Study Aim Clinical and electrocardiograpic findings and CK-MB levels are prognostic variables in the assessment of patients with chest pain. The aim of this study was to assess the enhanced prognostic value of the combined use of troponin I (TnI) and C-reactive protein (CRP) in non-selected patients who presented to the emergency department with chest pain. Research Design and Methods A cohort of 784 consecutive patients with chest pain was followed-up during 120 days until death or non-fatal myocardial infarction. TnI and CRP were prospectively obtained and investigators were blinded of test results. Results Of the 784 patients, 394 (50.2 %) were discharged with a diagnosis of non-ischemic pain and 390 (49.8%) were admitted with unstable angina or myocardial infarction. The overall rate of infarction or death at day 120 was 3.8%, but the greatest risk (14.9%) was seen in the group with both TnI and CRP elevation (p = 0.0001). Four independent predictors for death or myocardial infarction were identified: previous coronary artery disease, (HR = 2.97, 95% CI 1.42-6.25; p = 0.004); acute ST segment changes on admission (HR = 3.01, 95% CI 1.31-7.14; p = 0.009); TnI ≥ 0.4 ng/ml (HR = 2.85, 95% CI 1.23-6.66; p = 0.015) and CRP ≥ 5 mg/L (HR = 2.42, 95% CI 1.45-5.26; p = 0.020). Combined TnI and CRP provided superior risk stratification compared to conventional risk stratification, especially in the intermediate risk group. Conclusions In non-selected patients with chest pain, the combination of TnI and CRP provides an enhanced prognostic performance compared to conventional triage. This is most useful in patients with clinical intermediate risk.
Palabras clave : Angina Unstable; Prognosis; Coronary disease.