Heart Views (Jan 2013)

A comparative study of the C-reactive protein and the ST-score (ECG) as prognostic indicators in acute myocardial infarction in a rural resource-constrained hospital setting in central India: A cross-sectional study

  • Jyoti Jain,
  • Udit Ravinder Narang,
  • Vishakha Vinay Jain,
  • Om P Gupta

DOI
https://doi.org/10.4103/1995-705X.126882
Journal volume & issue
Vol. 14, no. 4
pp. 171 – 178

Abstract

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Context: The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events. Aims: The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India. Settings and Design: Cross sectional study, rural hospital in central India. Material and Methods: In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission. Statistical analysis used: We used Student′s t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals. Results: STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively. Conclusions: STS on admission is independent predictor while hs- CRP is not in resource constrained settings.

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