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

ABSTRACT

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. 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. Cross sectional study, rural hospital in central India. 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. 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. 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. STS on admission is independent predictor while hs- CRP is not in resource constrained settings.