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JACC March 12, 2019

Volume 73, Issue 9

Acute and Stable Ischemic Heart Disease

HSCRP PREDICTS MORTALITY BEYOND TROPONIN IN 102,337 PATIENTS WITH SUSPECTED ACUTE
CORONARY SYNDROME IN THE UK NATIONAL INSTITUTE FOR HEALTH RESEARCH CRP-RISK
STUDY
Moderated Poster Contributions
Acute and Stable Ischemic Heart Disease Moderated Poster Theater, Poster Hall, Hall F
Saturday, March 16, 2019, 10:45 a.m.-10:55 a.m.

Session Title: Biomarker Central: Role of Emerging Biomarkers in CAD

Abstract Category: 02. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1000-09

Authors: Amit Kaura, Adam Hartley, Vasileios Panoulas, Glampson Benjamin, Jim Davies, Kerrie Woods, Abdulrahim Mulla, Anoop D.
Shah, Keith Channon, Jonathan N. Weber, Mark R. Thursz, Paul Elliott, Harry Hemingway, Bryan Williams, Folkert W. Asselbergs, Rajesh
Kharbanda, Graham M. Lord, Narbeh Melikian, Riyaz Patel, Divaka Perera, Ajay Shah, Darrel Francis, Wolfgang Koenig, Jamil Mayet,
Ramzi Khamis, NIHR Imperial Biomedical Research Centre, Imperial College London, London, United Kingdom
Background: The incremental long-term prognostic value of hsCRP above troponin in a large real-world cohort of unselected patients
presenting with suspected acute coronary syndrome (ACS) is unknown.
Methods: We used the National Institute for Health Research (NIHR) Health Informatics Collaborative (NHIC) data of 257948 patients who
had a troponin measured at 5 UK cardiac centres. We excluded patients with an abnormal white cell count and hsCRP >15 mg/L to limit the
population to those without overt infection or inflammation.
Results: Following the exclusion criteria, 102337 patients were included in the analysis (hsCRP <2 mg/L (n=38390), 2-4.9 mg/L (n=27397),
5-9.9 mg/L (n=26957) and 10-15 mg/L (n=9593)). Using multivariate Cox regression, there was a positive and graded relationship between
hsCRP level and 3-year mortality (hazard ratio (95% CI)) of 1.39 (1.32-1.47) for those with hsCRP 2-4.9 mg/L, and 1.60 (1.52-1.69),
and 2.32 (2.18-2.46) for those with hsCRP from 5-9.9 mg/L and 10-15 mg/L, respectively (all p<0.0001), compared to those <2 mg/L
(reference). Figure 1 shows Kaplan-Meier mortality by hsCRP level and troponin positivity. The graded association between CRP and
mortality was seen in both ACS and non-ACS.
Conclusion: These multi-centre, real-world data from a large cohort of patients with suspected ACS identify hsCRP as a clinically
meaningful prognostic marker in addition to troponin and point to its potential utility in selecting patients for novel treatments targeting
inflammation.