C-reactive protein elevation and early outcome in patients with unstable angina pectoris

Oltrona, Luigi; Ardissino, Diego; Merlini, Piera Angelica; Spinola, Alessandra; Chiodo, F; Pezzano, Antonio

doi:10.1016/s0002-9149(97)00593-6

Cited by 56 publications

(40 citation statements)

References 25 publications

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“…Furthermore, among patients with angina pectoris, increases in CRP concentrations were associated with unfavorable short-and long-term outcomes. [14][15][16][17] In more recent years, several nested case-control and cohort studies have also reported that the risk for CVD was related to baseline CRP concentrations. 18,19 This relation was interpreted as a confirmation of the role of CRP itself as a risk factor for coronary disease by inducing mononuclear cells to express tissue factor, the initiator of the extrinsic pathway of coagulation, further stimulating vascular thrombosis.…”

Section: Introductionmentioning

confidence: 99%

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

Magadle

Weiner

Beckerman

et al. 2002

Clinical Cardiology

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SummaryBackground: Markers of inflammation, such as C-reactive protein (CRP), were found to be related to risk for cardiovascular disease (CVD) events in patients with angina pectoris. In addition, recent studies have shown that, in the case of atherosclerosis, increased CRP concentration reflects the inflammatory condition of the vascular wall.Hypothesis: The study was undertaken to determine whether CRP levels in individuals with chest pain attending the emergency room (ER) may be used as a marker of active CVD.Methods: Serum CRP level was measured in 226 of 326 consecutive patients (128 men, 98 women; mean age 61.3 ± 5.9 years; range 19-87 years) referred to the ER with chest pain. The decision whether to admit or release the subjects was determined without taking the CRP level into account. Follow-up was then performed for 1 year.Results: Eighty-four patients were admitted to the hospital. Of these, 9 with acute coronary syndrome (ACS) had very high levels of CRP (25-40 mg/l), 35 had had an acute coronary event within the preceding 3 months, with levels of CRP 14-20 mg/l. Only eight patients with nonsignificant CVD had elevated CRP levels. Twenty-eight subjects who were released from the ER had elevated CRP levels (7-14 mg/l); 8 of these, in addition to 4 subjects with normal CRP levels, had a late coronary event.

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Section: Introductionmentioning

confidence: 99%

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

Magadle

Weiner

Beckerman

et al. 2002

Clinical Cardiology

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“…Nineteen studies were selected; 15 were carried out by North American or European groups 1,[14][15][16][17][18][19][20][21][22][23][24][25][26][27] , three by Brazilian groups [28][29][30] and one by an Argentinean group 31 . All these studies were published in journals with an impact factor ≥ 3, except for two Brazilian studies 28,29 .…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…The sample size of the studies increased throughout the years, ranging from 32 to 7,108 patients (mean of 1,123 ± 1,674); seven studies had more than 1,000 patients 20,21,[23][24][25][26][27] , in a total of 21,339 patients studied. C-reactive protein was measured in all studies by means of a high-sensitivity method; 11 used nephelometry [14][15][16][17][18][19][21][22][23][24]26,[28][29][30] , three used turbidimetry 1,25,27 , one used luminometry 20 , and two used ELISA (Enzyme Liked Immunosorbent Assay) 31 .…”

Section: Characteristics Of the Studiesmentioning

confidence: 99%

“…First, the form of determination of the cut-off point for C-reactive protein: three studies identified the cut-off point by using the ROC curve and found 15 The second characteristic that differed among the studies was the definition of outcome measures, with two meta- (1,9 -13) Not Analyzed N: sample size; Cut-off point: in parenthesis, the method use to choose the reference value -whether using the best point in the ROC curve or arbitrarily; CRP ↑: C-reactive protein above the cut-off point; CRP ↓: C-reactive protein below the cut-off point. * Statistically significant difference of endpoints between patients with and without increased C-reactive protein; OR: odds ratio; RR: relative risk; HR: hazard ratio.…”

Section: Analysis Of Sensitivity Of the Prediction Of Long-term Eventsmentioning

confidence: 99%

“…Meta-analytic approach was used with the 12 studies which compared the incidence of events between two dichotomous groups according to the level of C-reactive protein [14][15][16][17]19,20,[25][26][27][29][30][31] . Duarte et al's study 28 was not included in this analysis because it assessed C-reactive protein as a continuous variable.…”

Section: Figura 3 -Summary Roc Curve Of the Association Of The Differmentioning

confidence: 99%

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Proteína C-reativa e prognóstico em síndromes coronarianas agudas: revisão sistemática e metanálise

Correia¹,

Esteves²

2011

Arq. Bras. Cardiol.

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Despite the association between high-sensitivity C-reactive protein (CRP) and recurrent events in non-ST elevation acute coronary syndromes (ACS), routine determination of this marker has not been recommended.In order to verify whether the current scientific evidence justifies the inclusion of CRP for risk stratification at hospital admission of patients with ACS, we carried out a systematic review and meta-analysis of the studies indexed in MEDLINE, SciELO or LILACS, with the following inclusion criteria: prospective cohort design and assessment of the prognostic value of CPR, as measured using a high-sensitivity method at the moment of hospital admission of patients with ACS. Nineteen studies met the inclusion criteria.In relation to the long-term follow-up, there was a consistent association between CRP and cardiovascular events, with an overall odds ratio (OR) of 4.6 (95% CI = 2.3 -7.6) and overall multivariate OR of 2.5 (95% CI = 1.8-3.4). As for the short-term, nine studies were positive and six were negative, with an overall OR of 1.65 (95% CI = 1.2-2.3). The overall multivariate OR was not obtained for the short-term follow-up, because this measurement was described only in three heterogeneous studies. Only two short-term studies analyzed the incremental predictive value of CRP in relation to multivariate models, with contradicting results.In conclusion, the small number of assessments of the incremental value of CRP, in conjunction with controversial results regarding the independent predictive value of CRP for short-term events does not support the recommendation of the routine use of CRP for risk stratification at admission of patients with ACS.

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Association of Fibrinogen, C-reactive Protein, Albumin, or Leukocyte Count With Coronary Heart Disease

Danesh¹,

Collins²,

Appleby³

et al. 1998

JAMA

1,903

1,267

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C-reactive protein elevation and early outcome in patients with unstable angina pectoris

Cited by 56 publications

References 25 publications

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

C‐reactive protein as a marker for active coronary artery disease in patients with chest pain in the emergency room

Proteína C-reativa e prognóstico em síndromes coronarianas agudas: revisão sistemática e metanálise

Association of Fibrinogen, C-reactive Protein, Albumin, or Leukocyte Count With Coronary Heart Disease

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