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

Abstract

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.

PCR e PCR-US como indicador de risco em doenças crônicas não-transmissíveis: uma revisão

“…Apesar disso, os achados reforçam a utilidade da PCR e da PCR-us em diferentes doenças crônicas não transmissíveis. Sendo que a presente revisão sistemática amplia e atualiza outras 4 revisões sistemáticas realizadas por Correia e Esteves (2011), Laks et al, (2011), Cardoso et al (2012), e Choi, Joseph e Pilote (2013) 15,[53][54][55] .…”

Does C-reactive Protein Add Prognostic Value to GRACE Score in Acute Coronary Syndromes?

“…In the 2000s, several studies were published in journals of high impact, favorable to the prognostic value of CRP in patients with ACS. These studies were analyzed as a systematic review and meta-analysis by our group, which was published in 2010 3 . Unlike the enthusiastic attitude of some authors, our review concluded that there was no conclusive evidence of the incremental prognostic value of CRP.…”

“…Among these markers, High-Sensitivity C-Reactive Protein (hs-CRP) is the best studied as a risk predictor in clinical practice 2 . Actually, several studies have shown an association between CRP and cardiovascular risk in patients with ACS 3 .…”

Biomarkers in Cardiology - Part 2: In Coronary Heart Disease, Valve Disease and Special Situations

“…A recently published systematic review found a positive association between elevated hs-CRP during ACS (with cutoff values between 10 and 15 mg/L) and long-term cardiovascular events, with a multivariate odds ratio of 2.5 (95% confidence interval: 1.8-3.4). The predictive power for short-term events was inconsistent, revealing heterogeneity in the results 14 . According to this same study, only 2 of the 19 prospective studies included in the analysis assessed the additional discriminatory ability for new events in multivariate models revealing opposite and, therefore, inconsistent results.…”