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European Heart Journal Advance Access published online on July 4, 2009
European Heart Journal, doi:10.1093/eurheartj/ehp273
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

C-reactive protein improves risk prediction in patients with acute coronary syndromes

François Schiele*, Nicolas Meneveau, Marie France Seronde, Romain Chopard, Vincent Descotes-Genon, Joanna Dutheil, Jean-Pierre Bassand on behalf on the ‘Reseau de Cardiologie de Franche Comte’

Department of Cardiology, Centre Hospitalier Universitaire Jean Minjoz, Université de Franche Comte, EA 3920 Boulevard Fleming, 25000 Besançon, France

Received 14 January 2009; revised 8 June 2009; accepted 11 June 2009 * Corresponding author. Tel: +33 381 668 539, Fax: +33 381 668 582, Email: francois.schiele{at}univ-fcomte.fr

Aims: Elevated C-reactive protein level is a risk marker in patients with acute coronary syndromes (ACSs), but current risk score systems do not consider this factor. We studied the incremental predictive value of adding C-reactive protein to the Global Registry of Acute Coronary Events (GRACE) risk score.

Methods and results: Characteristics, treatments and 30-day mortality were recorded for 1408/1901 consecutive ACS patients. Changes in global model fit, discrimination, calibration, and reclassification were evaluated upon addition of C-reactive protein to the GRACE risk score. High-C-reactive protein patients (C-reactive protein >22 mg/L, 4th quartile of C-reactive protein) were older, had more comorbidities and worse haemodynamic conditions, received less recommended treatment, and had a four-fold higher 30 day mortality. Multivariable analysis demonstrated high-C-reactive protein as an important and independent predictor of mortality. Addition of high-C-reactive protein in the GRACE model modestly improved global fit, discriminatory capacity (c-statistic from 0.795 to 0.823), and calibration. Patients were divided into four groups according to GRACE risk score prediction: <1, 1 to <5, 5 to <10, and ≥10%. The model with high-C-reactive protein allowed adequate reclassification in 12.2%.

Conclusion: Elevated C-reactive protein level is a modest but independent predictive factor of 30-day mortality in ACS patients, even after adjustment for co-morbidities, haemodynamic conditions, and treatment. Combined with the GRACE risk score, C-reactive protein information improves risk classification.

Key Words: C reactive protein • Acute coronary syndromes • Risk prediction


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