The CRP troponin test (CTT) stratifies mortality risk in patients with non‐ST elevation myocardial infarction (NSTEMI)

Author:

Brzezinski Rafael Y.1ORCID,Banai Shmuel2,Katz Shalhav Malka3,Stark Moshe4,Goldiner Ilana4,Rogowski Ori1ORCID,Shapira Itzhak1,Zeltser David3,Sasson Noa1,Berliner Shlomo1,Shacham Yacov2

Affiliation:

1. Internal Medicine “C” and “E”, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine Tel Aviv University Tel Aviv Israel

2. Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine Tel Aviv University Tel Aviv Israel

3. Department of Emergency Medicine, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine Tel Aviv University Tel Aviv Israel

4. Division of Clinical Laboratories, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine Tel Aviv University Tel Aviv Israel

Abstract

AbstractIntroductionThe C‐reactive protein (CRP)‐troponin‐test (CTT) comprises simultaneous serial measurements of CRP and cardiac troponin and might reflect the systemic inflammatory response in patients with acute coronary syndrome. We sought to test its ability to stratify the short‐ and long‐term mortality risk in patients with non‐ST elevation myocardial infarction (NSTEMI).MethodsWe examined 1,675 patients diagnosed with NSTEMI on discharge who had at least two successive measurements of combined CRP and cardiac troponin within 48 h of admission. A tree classifier model determined which measurements and cutoffs could be used to best predict mortality during a median follow‐up of 3 years [IQR 1.8–4.3].ResultsPatients with high CRP levels ( > 90th percentile, >54 mg/L) had a higher 30‐day mortality rate regardless of their troponin test findings (16.7% vs. 2.9%, p < 0.01). However, among patients with “normal” CRP levels ( < 54 mg/L), those who had high troponin levels ( > 80th percentile, 4,918 ng/L) had a higher 30‐day mortality rate than patients with normal CRP and troponin concentrations (7% vs. 2%, p < 0.01). The CTT test result was an independent predictor for overall mortality even after adjusting for age, sex, and comorbidities (HR = 2.28 [95% CI 1.56‐3.37], p < 0.01 for patients with high troponin and high CRP levels).ConclusionsEarly serial CTT results may stratify mortality risk in patients with NSTEMI, especially those with “normal” CRP levels. The CTT could potentially assess the impact of inflammation during myocardial necrosis on the outcomes of patients with NSTEMI and identify patients who could benefit from novel anti‐inflammatory therapies.

Publisher

Wiley

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