Objective. To investigate whether assessment of C-reactive protein (CRP) and apolipoproteins, besides the traditional lipid profile, enhances the assessment process for the risk of acute coronary syndrome (ACS). Methods. The study group consisted of 220 consecutive patients admitted to hospital within the first 6 hours from the onset of chest pain. Patients were diagnosed with unstable angina ( ), non-ST-elevation myocardial infarction (NSTEMI; ), or ST-elevation myocardial infarction (STEMI; ). ACS patients were compared with 116 healthy volunteers in a case-control study. The serum was assayed on admission for CRP, apolipoproteins ApoAI and ApoB100, and lipid parameters. Results. The highest concentrations of CRP were found in NSTEMI and STEMI, with a median value four-fold higher in ACS patients than in controls ( ). Only CRP significantly increased the probability of ACS development (adjusted odds ratio for a 1？mg/L increase 1.90; 95% confidence interval [CI] 1.34–2.89) and explained 90% of the variation for ACS development. Similarly, we demonstrated the highest diagnostic accuracy for CRP among all investigated markers (area under the curve 0.80; 95% CI 0.75–0.85). Conclusions. Our study indicates that CRP superiorly to apolipoproteins and lipid profile facilitates the risk stratification for ACS occurrence. 1. Introduction Despite great progress in pharmacotherapy and interventional treatment, acute coronary syndromes (ACS) remain the major cause of mortality and morbidity in the modern world [1]. Inflammation plays a key role in the initiation and promotion of atherosclerotic lesions and can trigger ACS by the induction of plaque instability. C-reactive (CRP) protein is an extensively studied inflammatory factor whose prognostic value in cardiovascular diseases in recent years has become increasingly important [2–7]. Additionally, CRP is no longer merely considered a marker but also emerges as a mediator of atherosclerosis [8, 9]. Thus, considering the generally available lipid profile a tool for risk assessment, it seems that CRP and the lipid profile besides the patient’s clinical characteristics could lead to the most tangible benefit for assessing the risk of ACS development. On the other hand, in recent years the value of CRP in this setting has been extensively debated. In a large meta-analysis of 22 prospective studies in healthy individuals, Danesh et al. found that in studies published after 2000, the prognostic value of CRP in predicting ACS was much weaker than in a meta-analysis of research results from before 2000 [10]. This led to
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