Prior aspirin use and its relationship with the prog­nostic value of e-Reactive protein in non-ST-elevation acute coronary syndromes

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Abstract

Background C-reactive protein (CRP) is an independent prognostic marker of death in patients with non-ST-elevation coronary syndromes. Previous reports suggest that CRP lost its predictive value m patients with prior aspirin therapy. Objectives The aim of this study is to assess the interaction between prior aspirin use, basal CRP values and its predictive value for death at 180 days after admission. Material and methods. We prospectively evaluate 1520 consecutive patients with non-ST-elevation acute coronary syndromes in the PACS Study (Prognosis in Acute Coronary Syndromes). A total of 777 patients (51.1%) were taking aspirin the month before the admission (ASA+) and 743 patients (48.9%) did not use the drug (ASA-). We made one high sensitivity CRP (hsCRP) assay at entry with a median time after the onset of symptoms of 9 ± 1 hours. CRP values were blind until the end of the study. The association between admission hsCRP values, prior aspirin use and mortality at 180 d were assessed with chi-square and·cox regression tests.

Results

Mean admission hsCRP values were not different according to prior aspirin use (11.04 mg/L in the ASA+ group and 9.74 mg/L in ASA- group; p = NS). Global mortality rate at day 180 was 5.2%. Mortality rate was 2.8% and 6.8% in the hsCRP < 3 mg/L group and in the hsCRP > 3 mg/L, respectively (OR 2.52[1.45-4.35]; p = 0.001). Mortality rate in AAS- group was 1.6% for hsCRP < 3 mg/1 and 5.7% for hsCPR > 3 mg/L [OR 3.6 (IC95 1.4-9.7; p = 0.004)]. Mortality rate in AAS+ group was 4% in the hsCRP<3 mg/L and 7.7% for hsCRP > 3mg/L [OR 2.0 (IC95 1.0-4.0; p = 0.048)]. The risk in the CRP > 3 mg/L was greater in the ASA- group (OR 3.6 vs 2.0 p < 0.05).

Conclusion

Prior aspirin use did not modify hsCRP values at admission and was associated with a greater mortality at day 180. The predictive value of hsCRP was attenuated, but not nule, in patients with previous aspirin therapy.