Value of high-sensitivity C-reactive protein in low risk chest pain observation unit patientsReport as inadecuate

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International Journal of Emergency Medicine

, 4:37

First Online: 24 June 2011Received: 26 December 2010Accepted: 24 June 2011


ObjectiveHigh-sensitivity C-reactive protein hs-CRP rises with cardiac injury-ischemia. We evaluated its efficacy in aiding in the identification of an acute coronary syndrome ACS in patients pts admitted to the chest pain unit CPU for possible ACS.

MethodsRetrospective study of all patients admitted to the CPU with chest pain who underwent hs-CRP testing as part of their CPU evaluation from January 2004 to October 2008. Patients were low risk for ACS compatible symptoms, nondiagnostic initial ECG, and negative cTnI. ACS was diagnosed by positive functional study, cardiac catheterization, or cardiac event during 30-day follow-up. Positive hs-CRP was defined based on local laboratory levels >1.0 mg-l or >3.0 mg-l, and population-based and prior study values >2.0 mg-l. Chi-square analysis was performed, and odds ratios OR are presented. Multivariate analysis was done to determine whether hs-CRP was independently associated with the diagnosis of ACS. Cardiac risk factors, demographics, and diagnosis of ACS were included in the model. Medians with IQR are presented for continuous data. Ninety-five percent confidence intervals are presented where applicable.

ResultsA total of 958 patients had hs-CRP testing as part of their CPEU evaluation. Excluded from the analysis were 39 patients lost to follow-up. The final cohort comprised 478 52% women and 441 48% men with a median age of 56 IQR 48-64. ACS was diagnosed in 128 13.4%. The median cohort hs-CRP value was 2.2 mg-l IQR 0.7, 5.8 and 2.3 mg-l IQR 0.6, 5.9 in those with and without ACS, respectively. In the multivariate analysis hs-CRP was not independently associated with the diagnosis of ACS 0.99; 95% CI 0.98 - 1.01.

ConclusionIn large patient cohort managed in a single-center CPU, measurement of hs-CRP did not enhance the diagnostic accuracy for ACS. Routine hs-CRP as a diagnostic tool should not be recommended in the CPU setting.

Electronic supplementary materialThe online version of this article doi:10.1186-1865-1380-4-37 contains supplementary material, which is available to authorized users.

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Author: Deborah B Diercks - J Douglas Kirk - Seif Naser - Samuel Turnipseed - Ezra A Amsterdam


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