Prognostic value of C-reactive protein in unstable angina.

Unstable Angina To the Editor: We appreciate the work by Ferreirós et al in confirming the strong prognostic value of C-reactive protein (CRP) in unstable angina. However, we believe that some issues should be raised. First, the authors did not exclude patients with Braunwald type C unstable angina and they did not provide an explanation of this choice. Class C unstable angina has a strong prognostic role in prospective studies. Confirming this fact, in their Table 1, the time between prior acute myocardial infarction (AMI) and the occurrence of unstable angina was not specified, and the group of patients with raised CRP (.1.5 mg/dL) had a higher, yet not statistically significant, prevalence of prior AMI. In fact, the pathophysiological meaning of a raised CRP titer is quite different in a patient recovering from a recent AMI than in a patient with unstable angina without previous myocardial necrosis. Moreover, in the Results and Discussion sections, the authors did not emphasize the prognostic value of CRP in refractory angina alone. Instead, several prospective studies considered, in the outcome analysis, either major cardiac events (AMI/death) alone or minor (recurrence of angina) and major cardiac events evaluated as different end points.