Inclusion of high-sensitivity C-reactive protein levels enhances the predictive ability of the Grace risk score

By Samar Mahmoud, MS
Published January 27, 2022

Key Takeaways

  • This single-center, retrospective, observational study found that an elevated high-sensitivity C-reactive protein (hs-CRP) level upon admission was predictive of in-hospital outcomes in patients with acute myocardial infarction (AMI). 

  • The addition of hs-CRP to the Global Registry of Acute Coronary Events (Grace) score improves the identification of clinical outcomes in AMI patients. 

  • Prospective, multicenter studies are needed to confirm these findings.

Acute myocardial infarction (AMI) is a leading cause of mortality and morbidity worldwide. For patients with AMI, early risk stratification is critical to guiding clinical decisions. The Grace score, which takes into account serum creatinine and troponin levels, is a commonly utilized tool for assigning risk scores to AMI patients. 

Why This Study Matters

It is not clear whether the predictive power of the Grace risk score can be improved by the addition of other biomarkers. An attractive candidate is hs-CRP, a biomarker of inflammation, which has been shown to be predictive of outcomes in patients with AMI.  This study sought to determine the relationship between hs-CRP and the Grace risk score in patients diagnosed with AMI.

Study Design

The study enrolled 1804 patients diagnosed with AMI, who underwent a percutaneous coronary intervention, between January 2019 to December 2019.  Upon admission, serum hs-CRP as well as indicators included in the Grace risk scoring model were obtained from each patient. Patients were divided into four groups by quartiles of serum hs-CRP levels. 

The primary outcome of the study was a composite score of death, malignant arrhythmia, mechanical complication, congestive heart failure (HF), cardiogenic shock, thrombosis, bleeding, and stroke. 

Results and Conclusions

The average participant age was 59 years and males comprised 80.3 % of subjects.

The highest quartile of hs-CRP was linked to in-hospital outcomes such as death, HF, cardiogenic shock, bleeding, and mechanical complications.  Investigators observed a significant positive correlation (r = .191, p < .001) between hs-CRP levels and the Grace risk score model. 

The clinical benefit of a model combining hs-CRP levels and the Grace risk score model was significantly higher than the traditional Grace mode alone. 

Related Research

Consider these findings from similar research studies:

  • The addition of serum uric acid levels to GRACE risk score improves prediction of in-hospital death (Source). 

  • C-reactive protein levels predict incidence of heart failure in patients with ST-elevation myocardial infarction (Source).

Original Source 

Lin XL, Sun HX, Li FQ, et al. Admission high‐sensitivity C‐reactive protein levels improve the Grace risk score prediction on in‐hospital outcomes in acute myocardial infarction patients. Clinical Cardiology. Published online January 23, 2022:clc.23749.

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