C-reactive protein as a predictor of malignant ventricular arrhythmias in non-ST elevation myocardial infarction

Cheng-Gang WANG; Xiu-Chuan QIN; Shao-Ping NIE; Chun-Mei WANG; Hui AI; Bin QUE

doi:10.11909/j.issn.1671-5411.2019.08.007

摘要：Objective To investigate whether C-reactive protein (CRP) is a biomarker of malignant ventricular arrhythmias (MVA) occunring in non-ST elevation myocardial infarction (NSTEMI) patients with Global Registry of Acute Coronary events (GRACE) scores ＜ 140.Methods A total of 1450 NSTEMI patients were included in this study.Hs-CRP blood levels were measured via a turbidimetric immunoassay after confirming the diagnosis of NSTEMI with GRACE scores ＜ 140.Results Consistent with prior studies,the MVA occurrence rate in our cohort was 6.7％,and patients with MVA exhibited a reduced left ventricular ejection fraction (46.1％ ± 6.9％ vs.61.5％ ± 8.7％,P =0.032),a higher incidence of Killip classification ＞ 1 (34.1％ vs.24.2％,P ＜ 0.001),an increased surgical revascularization rate (34.1％ vs.9.7％,P ＜0.001),and increased mortality (16.5％ vs.5.8％,P ＜ 0.001).Serum hs-CRP levels were higher (P =0.003) in NSTEMI patients with MVA,and this increase appeared unrelated to other clinical parameters.The C-statistic to discriminate MVA was 0.82 (95％ CI:0.74-0.89).Using receiver operating characteristics analysis,we optimized a cutoff point of 16 mL/L,and the sensitivity and specificity were 95％ and 61％,respectively;the positive predictive value was 20％ and the negative predictive value was 99％.Conclusions An hs-CRP assay is a potential MVA biomarker in low-risk NSTEMI patients with GRACE scores ＜ 140.If validated in prospective studies,hs-CRP may offer a low-cost supplementary strategy for risk stratification for NSTEMI patients.