Foussas Stefanos G, Zairis Michael N, Lyras Anastassios G, Patsourakos Nikolaos G, Tsirimpis Vasilios G, Katsaros Kostas, Beldekos Demetrios J, Handanis Stelios M, Mytas Demetrios Z, Karidis Kostas S, Tselioti Paraskevi G, Prekates Athanasios A, Ambrose John A
Department of Cardiology, Tzanio Hospital, Piraeus, Greece.
Am J Cardiol. 2005 Aug 15;96(4):533-7. doi: 10.1016/j.amjcard.2005.04.015.
The aim of the present study was to evaluate whether an elevated plasma C-reactive protein (CRP) level provides any additional prognostic information to the validated Thrombolysis In Myocardial Infarction (TIMI) risk score in patients with acute coronary syndromes. For this purpose, 1,846 consecutive patients with either acute ST-segment elevation myocardial infarction (STEMI; 861 patients) or non-ST-segment elevation acute coronary syndrome (NSTEACS; 985 patients) were included. The incidence of 30-day death and 14-day composite of death, myocardial infarction (or repeat myocardial infarction) and recurrent ischemia was the prespecified primary end point in the STEMI and NSTEACS cohorts, respectively. The incidence of the primary end point was 9.8% and 23.6% in the STEMI and NSTEACS cohorts, respectively. A significantly increased risk of the primary end point was present with an increase in the STEMI and NSTEACS TIMI risk score (p(trend) < 0.001 for the 2 groups). A plasma CRP value of > or = 5 and > or = 3 mg/L (defined by receiver-operating characteristic analysis) was associated with a significantly increased risk of the primary end point in the STEMI and NSTEACS cohorts, respectively (p < 0.001 for the 2 cohorts), and it was true throughout the subgroups of STEMI and NSTEACS TIMI risk scores. In conclusion, an elevated plasma CRP level appears to be a marker that adds prognostic information to the validated STEMI and NSTEACS TIMI risk score. The plasma CRP and TIMI risk score may be used together for enhanced risk stratification in the setting of acute coronary syndromes.
本研究的目的是评估血浆C反应蛋白（CRP）水平升高是否能为急性冠状动脉综合征患者经验证的心肌梗死溶栓（TIMI）风险评分提供额外的预后信息。为此，纳入了1846例连续的急性ST段抬高型心肌梗死（STEMI；861例患者）或非ST段抬高型急性冠状动脉综合征（NSTEACS；985例患者）患者。30天死亡发生率以及STEMI和NSTEACS队列中分别预先设定的14天死亡、心肌梗死（或再发心肌梗死）和再发缺血的复合发生率为主要终点。STEMI和NSTEACS队列中主要终点的发生率分别为9.8%和23.6%。STEMI和NSTEACS的TIMI风险评分增加时，主要终点风险显著增加（两组p趋势<0.001）。血浆CRP值≥5 mg/L和≥3 mg/L（通过受试者工作特征分析定义）分别与STEMI和NSTEACS队列中主要终点风险显著增加相关（两个队列p<0.001），并且在STEMI和NSTEACS的TIMI风险评分亚组中均如此。总之，血浆CRP水平升高似乎是一种可为经验证的STEMI和NSTEACS TIMI风险评分增加预后信息的标志物。血浆CRP和TIMI风险评分可共同用于急性冠状动脉综合征情况下增强风险分层。
