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

Rafael Y. Brzezinski*, Shmuel Banai, Malka Katz Shalhav, Moshe Stark, Ilana Goldiner, Ori Rogowski, Itzhak Shapira, David Zeltser, Noa Sasson, Shlomo Berliner, Yacov Shacham

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: The 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). Methods: We 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]. Results: Patients 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). Conclusions: Early 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.

Original languageEnglish
Article numbere24256
JournalClinical Cardiology
Volume47
Issue number4
DOIs
StatePublished - Apr 2024

Funding

FundersFunder number
Dalia and Arie Pershkovsky

    Keywords

    • CRP
    • NSTEMI
    • acute coronary syndrome
    • inflammation
    • troponin

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