CLINICAL STUDIES
Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis
Christopher Heeschen, MD*,
Christian W. Hamm, MD, FACC ,
Jens Bruemmer, MD ,
Maarten L. Simoons, MD, FACC for the CAPTURE Investigators
* Stanford University Medical School, Department of Cardiovascular Medicine, Stanford, California, USA
Kerckhoff-Clinic, Department of Cardiology, Bad Nauheim, Germany
University Hospital Hamburg, Department of Clinical Chemistry, Hamburg, Germany
Erasmus University Rotterdam, Thoraxcenter, Rotterdam, the Netherlands
Manuscript received June 28, 1999;
revised manuscript received December 7, 1999,
accepted January 20, 2000.
Reprint requests and correspondence: Dr. Christopher Heeschen, Stanford University School of Medicine, Department of Cardiovascular Medicine, 300 Pasteur Drive, Stanford, California 94305-5406
heeschen{at}stanford.edu
OBJECTIVES
We evaluated C-reactive protein (CRP) and troponin T (TnT) for predicting six-month cardiac risk in patients with unstable angina.
BACKGROUND
Troponin T is predictive of cardiac risk in patients with unstable angina. The clinical implications of elevated CRP in such patients remains controversial.
METHODS
Baseline TnT and CRP values were determined in 447 patients with unstable angina enrolled in the placebo group of the Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial (CAPTURE) trial. All patients underwent a coronary intervention and were followed for a six month period in which 13 deaths and 47 myocardial infarctions were documented (MIs).
RESULTS
Troponin T was >0.1 µg/liter in 30% and CRP was >10 mg/L in 41% of the patients. For the initial 72-h period (including coronary intervention), TnT (17.4% vs. 4.2%; p < 0.001) but not CRP (10.3% vs. 8%; p = 0.41) was predictive of mortality and MI. The TnT-positive patients displayed more frequent recurrent instability before the planned intervention (44.8% vs. 16.9%; p < 0.001), but in the CRP-positive patients, no such increase was observed (25.9% vs. 24.8%; p = 0.92). In contrast, for the six month follow-up period, CRP was predictive of cardiac risk (mortality, MI) (18.9% vs. 9.5%; p = 0.003). Using multivariate analysis, both CRP and TnT emerged as independent predictors of mortality and MI at six- month follow-up. Furthermore, the incidence of coronary restenosis during six-month follow-up was not related to TnT status (3% vs. 4.5%; p = 0.49); however, it was significantly related to CRP status (7% vs. 2.3%; p = 0.03).
CONCLUSIONS
Troponin T, but not CRP, was predictive of cardiac risk during the initial 72-h period, whereas CRP was an independent predictor of both cardiac risk and repeated coronary revascularization (coronary artery bypass graft surgery and percutaneous transluminal coronary angioplasty) during six month follow-up.
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Abbreviations and Acronyms
| | CABG | = coronary artery bypass graft surgery | | CAPTURE | = Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial | | CI | = confidence interval | | CK | = creatine kinase | | CRP | = C-reactive protein | | FRISC | = FRagmin during InStability in Coronary artery disease trial | | MI | = myocardial infarction | | OR | = odds ratio | | PTCA | = percutaneous transluminal coronary angioplasty | | TnT | = troponin T |
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