Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies.

OBJECTIVE To assess the overall effects by a meta-analysis. DATA SOURCES Electronic searches on PubMed and Ovid Medline from their start to October 2009 were carried out. Objective Cohort studies and secondary analysis of randomised controlled trials reporting the relative risk (RR) of recurrent cardiovascular events or death associated with C-reactive protein (CRP) obtained within 72 h from acute coronary syndromes (ACS) onset. DATA EXTRACTION Two epidemiologists independently abstracted information on study design, study and participant characteristics, level of CRP, outcomes, control for potential confounding factors and risk estimates using a standardised form. RESULTS A general variance-based method was used to pool the estimates of risk. Thirteen studies containing 1364 new cases identified from 9787 patients during the follow-up periods reported the risk estimates by CRP categories. Compared with the bottom CRP category (< or = 3 mg/l), the pooled RRs and their 95% CIs were 1.40 (1.18 to 1.67) for the middle (3.1 approximately 10 mg/l) category and 2.18 (1.77 to 2.68) for the top (>10 mg/l) category of CRP values with a random-effects model, respectively. Another four and three studies reported the risk by unit of CRP or logarithmically transformed CRP. The pooled RRs (95% CI) were 1.49 (1.06 to 2.08) per 5 mg/l and 1.26 (0.95 to 1.69) per natural logarithm of CRP (mg/l), respectively. CONCLUSIONS Greater early blood CRP moderately increases long-term risk of recurrent cardiovascular events or death, and may be a valuable prognostic predictor in patients after ACS.