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Abstract
Markers of myocyte necrosis such as cardiac troponin or creatine kinase-myocardial
band are invaluable tools for risk stratification among patients presenting with acute
coronary syndromes (ACS). Nonetheless, many patients without any evidence of myocyte
necrosis may be at high risk for recurrent ischemic events. In consideration of the
important role that inflammatory processes play in determining plaque stability, recent
work has focused on whether plasma markers of inflammation may help improve risk stratification.
Of these markers, C-reactive protein (CRP) has been the most widely studied, and there
is now robust evidence that CRP is a strong predictor of cardiovascular risk among
apparently healthy individuals, patients undergoing elective revascularization procedures,
and patients presenting with ACS. Moreover, even among patients with troponin-negative
ACS, elevated levels of CRP are predictive of future risk. Other, more upstream markers
of the inflammatory cascade, such as interleukin (IL)-6, have also been found to be
predictive of recurrent vascular instability. A recent report from the second FRagmin
during InStability in Coronary artery disease trial investigators suggests that elevated
levels of an inflammatory marker such as IL-6 may indicate which patients may benefit
most from an early invasive strategy. Other inflammatory markers currently under investigation
include lipoprotein-associated phospholipase A(2), myeloperoxidase, and pregnancy-associated
plasma protein A. Of all these novel markers, CRP appears to meet most of the criteria
required for potential clinical application. Furthermore, the benefits of lifestyle
modification and drug therapy with aspirin or statins may be most marked among those
with elevated CRP levels.