Determinación combinada de proteína C reactiva y troponina I en pacientes que concurren a la Unidad de Emergencias con dolor precordial

introduction and study aim clinical and electrocardiograpic findings and ck-mb levels are prognostic variables in the assessment of patients with chest pain. the aim of this study was to assess the enhanced prognostic value of the combined use of troponin i (tni) and c-reactive protein (crp) in non-selected patients who presented to the emergency department with chest pain. research design and methods a cohort of 784 consecutive patients with chest pain was followed-up during 120 days until death or non-fatal myocardial infarction. tni and crp were prospectively obtained and investigators were blinded of test results. results of the 784 patients, 394 (50.2 %) were discharged with a diagnosis of non-ischemic pain and 390 (49.8%) were admitted with unstable angina or myocardial infarction. the overall rate of infarction or death at day 120 was 3.8%, but the greatest risk (14.9%) was seen in the group with both tni and crp elevation (p = 0.0001). four independent predictors for death or myocardial infarction were identified: previous coronary artery disease, (hr = 2.97, 95% ci 1.42-6.25; p = 0.004); acute st segment changes on admission (hr = 3.01, 95% ci 1.31-7.14; p = 0.009); tni ≥ 0.4 ng/ml (hr = 2.85, 95% ci 1.23-6.66; p = 0.015) and crp ≥ 5 mg/l (hr = 2.42, 95% ci 1.45-5.26; p = 0.020). combined tni and crp provided superior risk stratification compared to conventional risk stratification, especially in the intermediate risk group. conclusions in non-selected patients with chest pain, the combination of tni and crp provides an enhanced prognostic performance compared to conventional triage. this is most useful in patients with clinical intermediate risk.