high-sensitivity crp som prognostisk markør ved akutt koronar syndrom : - et hjelpemiddel til risikostratifisering

Abstract

Abstract

Background: Recent years have witnessed a growing enthusiasm to obtain biomarkers for clinical use in prediction of future cardiovascular events in patients presenting with acute coronary syndrome (ACS). This has lead to a growing body of evidence emphasizing the role of high sensitive C-reactive protein (hsCRP) as a marker of morbidity and mortality in these patients, and by that it’s potential for risk stratification. In this study, I have reviewed some of the literature that highlights hsCRP as a marker of prognosis in patients presenting with ACS in an attempt to evaluate and discuss them.

Methods: A literature search was conducted using Medline and PubMed. I searched for literature published in English between January 1991 and august 2006. The search was further limited to include randomized controlled studies, clinical trials and cohort studies. The selection of articles was based on relevance according to title and abstract, and by the use of ”American Heart Association’s ILCOR evaluation process”.

Results: Six prospective cohort studies, 3 published in the High Impact Factor journal ”The New Engl J Med” (44.016) and 3 in lower Impact Factor journals describing the role of CRP in predicting outcome in ACS were selected and subjected the use of CRP in risk-stratifying patients with ACS. Objections could be raised in all 6 studies, particularly as to description and qualifying the CRP method and cut-off values, population size, follow up time, “drop-outs” and sex-distribution (mostly men).

Conclusions: Based on a targeted literature search and by applying approved evaluation formates, 6 prospective cohort studies were examined in detail, in order to evaluate the role of serum CRP measurements in predicting outcome in patients presenting with Acute Coronary Syndromes. All studies but one, recommend the use of CRP to reach this end, however CRP methodology standardization and cut-off values remain to be finalized