After ACS, serial high-sensitivity CRP measurements are prognostic

  • Mani P & al.
  • JAMA Cardiol
  • 6 Mar 2019

  • International Clinical Digest
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Takeaway

  • A rise in high-sensitivity C-reactive protein (hsCRP) after acute coronary syndrome (ACS) was associated with elevated risk for major adverse cardiac event (MACE) and death within 4 months.

Why this matters

  • After ACS, risks for further ischemic cardiovascular events and death are elevated.
  • hsCRP measurements shortly after ACS have been linked to short-term outcomes, but it has been unclear whether serial measurements carry extra prognostic value.

Key results

  • Adjusted HRs (95% CIs) with baseline and longitudinal hsCRP for:
    • MACE: 1.36 (1.13-1.63; P=.001) and 1.15 (1.09-1.21; P<.001 class=""> 
    • Cardiovascular death: 1.61 per SD (1.07-2.41; P=.02) and 1.26 per SD (1.19-1.34; P<.001>
    • All-cause death: 1.58 per SD (1.07-2.35; P=.02) and 1.25 per SD (1.18-1.32; P<.001>

Study design

  • Secondary analysis of double-blind, multicenter, randomized clinical VISTA-16 trial (n=4257). 
  • Patients presenting within 96 hours of ACS were randomly assigned to take investigative phospholipase A2 inhibitor vs placebo for 16 weeks.
  • Researchers measured hsCRP at baseline and 1, 2, 4, 8, 16 weeks.
  • Outcome: MACE (cardiovascular death, nonfatal myocardial infarction or stroke, or hospitalization for unstable angina).
  • Funding: Anthera Pharmaceuticals.

Limitations

  • Drug being studied was linked to harm; hsCRP rise may have reflected that.