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

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), Student's t-test, Fisher's 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 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 8 mg/L in group I (AMI) patients (P 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. INTRODUCTION Acute Coronary Syndrome refers to a spectrum of clinical conditions comprising of Unstable Angina, Non-Q-wave Myocardial Infarction and Acute Myocardial Infarction. Unstable Angina (UA) is defined as angina pectoris (or equivalent type of ischemic chest discomfort) with presence of at least one of the following three features1: 1) It occurs at rest (or with minimal exertion) usually lasting more than 20 minutes (if not interrupted by nitroglycerin); 2) It is severe and described as frank pain and of new onset (i.e. within 1 month); and 3) It occurs with a crescendo pattern (i.e. more severe, prolonged, or frequent than previously). Unstable Angina is classified according to Braunwald’s classification2, which is based on the severity of the ischemia. Patients with unstable angina may be further divided according to the intensity of the prior treatment for angina and on the basis of the presence or absence of electrocardiographic changes during the episode of pain. In unstable angina, ST segment depression (or transient ST segment elevation) and T wave changes occur in upto 50 per cent of patients.3 Non-Q-wave Myocardial Infarction (Non-ST segment elevation MI, NSTEMI) Among the patients with the pattern of ischemic chest discomfort consistent with unstable angina, especially those with prolonged rest pain, the diagnosis of NSTEMI is made if there is biochemical evidence of myocardial necrosis, that is, a positive CK-MB, troponin T or I or potentially other markers of injury. Acute Myocardial Infarction: The classic WHO criteria for the diagnosis of acute myocardial infarction require that at least two of the following three elements be present7: 1) A history of ischemic type chest discomfort for atleast 30 minutes, 2) Evolutionary changes on serially obtained ECG tracings, and