Markers of myocardial damage and inflammation in patients with coronary artery disease

Abstract

To shed light on the clinical significance of elevated CRP levels we performed a comparative analysis of the predictive values of both CRP and TnT in patients with unstable coronary artery disease for the occurrence of major cardiac events within 6 months. CRP and Troponin T were measured on admission in patients with acute coronary syndromes without ST segment elevation. Patients were treated according to a conservative management and the incidence of major cardiac events within 6 months was assessed. A total of 73 patients were included in the study. There were 27 major cardiac events (37%). An abnormal CRP (>4 mg/L) and an abnormal TnT (> 0.01 mg/L) were present in 36 patients (49.3%). The incidence of a major cardiac event was significantly higher among patients with CRP > 4 mg/L than in other patients (63.9 vs 10.8%), and this was evident both in patients with an elevated TnT (85.7 vs 20%) and in those without an elevated TnT (33.3 vs 4.5%). The sensitivity of a concentration of CRP > 4 mg/L for predicting a future ischaemic event was 85%, with a specifity of 72% and negative predictive value of 89%. For TnT > 0.01 mg/L the sensitivity was 77%, specifity 67% and negative predictive value 84%. The present study shows that both CRP, a non-specific acute phase reactant, and TnT, a cardiac specific marker of myocardial damage, are elevated early in a substantial number of patients with acute coronary syndromes. It shows that CRP and TnT are independent prognostic indicators of adverse ischaemic events.