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RESEARCH PRODUCT

C-Reactive Protein in Acute Coronary Syndrome. Looking Back in Order to Move Forward

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Recent years have seen a spectacular rise in the importance of biomarkers in acute coronary syndrome (ACS). The most notable of these biomarkers is, without doubt, troponin. Its usefulness for diagnosis, decision making, and prognostic stratification have been fully validated, and its use in daily clinical practice is now widespread.1 It should be pointed out that the kinetics of troponin release were studied in detail for different types of ACS right from the outset. This approach has clearly laid a solid foundation which has contributed to the current popularity of this marker. However, it was soon evident that not all patients with ACS and elevated troponin had a very poor prognosis,2-6 and that patients with chest pain and normal troponin levels did not always have an excellent prognosis.7,8 It therefore became clear that other factors besides troponin levels and electrocardiographic findings needed to be taken into account. A full clinical evaluation of the patients using risk scales,7 early stress tests,8 and gathering all available information in dedicated chest pain units8 have proved decisive developments. Alongside these, the incorporation into daily practice of new biomarkers has provided another important tool.1,2 Biochemical information can currently be obtained for almost all pathophysiological processes implicated in ACS1,2,5 but, besides troponin, the marker that has deserved most attention in the last decade is C-reactive protein (CRP).2-6 Recognition of the importance of inflammation in the development of arteriosclerotic disease in general and ACS in particular has arisen in parallel with interest in CRP.1,2 After years of investigation, we now have fairly precise knowledge of the role this biomarker plays in non-ST-elevation ACS. Unlike C-Reactive Protein in Acute Coronary Syndrome. Looking Back in Order to Move Forward