***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: BACKGROUND Elevated C-reactive protein ( CRP ) is associated with adverse outcomes in non-ST-segment elevation acute coronary syndromes ( NSTE-ACS ) ; however , the prognostic significance of serum amyloid A ( SAA ) , also an important inflammatory marker , remains unclear . METHODS AND RESULTS The ability of SAA , in combination with CRP , to predict clinical outcomes was evaluated in 277 patients with NSTE-ACS . Patients were classified according to the presence or absence of elevated SAA ( > 0.8 mg/dl ) and elevated high-sensitivity CRP ( > 0.200 mg/dl ) on admission : group 1 , both SAA and CRP normal ( n=133 ) ; group 2 , SAA normal , but CRP elevated ( n=30 ) ; group 3 , SAA elevated , but CRP normal ( n=28 ) ; and group 4 , both SAA and CRP elevated ( n=86 ) . In groups 1 , 2 , 3 , and 4 , the rates of combined endpoints including death , (re)infa rct ion , or urgent target-vessel revascularization at 30 days were 8 % , 3 % , 25 % , and 23 % , respectively ( p=0.002 ) . Multivariate analysis showed that as compared with group 1 , the odds ratios for combined endpoints in groups 2 , 3 , and 4 were 0.50 ( p=0.30 ) , 1.95 ( p=0.038 ) , and 1.86 ( p=0.044 ) , respectively . CONCLUSIONS Regardless of the level of CRP , elevated SAA is associated with adverse 30-day outcomes in patients with NSTE-ACS , so SAA is a better predictor of clinical outcome than CRP in these patients This study assessed the prognostic value of cardiac troponin I ( cTnI ) and C-reactive protein ( CRP ) in unstable angina , and specifically in patients with angiographically proven coronary artery disease . These biochemical parameters , which are related to myocardial injury or to systemic inflammation , may help in short-term risk stratification of unstable angina . We prospect ively studied 195 patients with unstable angina , 100 of whom had angiographically proven coronary artery disease ( with normal creatine kinase [ CK ] and CK-MB mass ) .  Serum concentrations of  cTnI  ( N < 0.4 ng/ml ) and CRP ( N < 3 mg/L ) were measured at admission , 12 , and 24 hours later . The rate of in-hospital major adverse cardiac events ( death , myocardial infa rct ion , or emergency revascularization ) was higher in patients with increased cTnI within the first 24 hours , regardless of the results of coronary angiography ( 23 % vs 7 % ; p < 0.001 ) . Conversely , events occurred at similar rates in patients with or without increased CRP . In patients with angiographic evidence of coronary artery disease , multivariate analysis showed that increased cTnI within 24 hours of admission ( 35 patients ) was an independent predictor of major adverse cardiac events ( odds ratio 6.7 , range 1.7 to 27.3 ) , but not cTnI levels at admission and CRP at 0 , 12 , and 24 hours . Thus , both in unselected patients with unstable angina and in patients with angiographically proven coronary artery disease , increased cTnI within 24 hours of admission , but not CRP , is a predictor of in-hospital clinical outcome . We also found a temporal link between cTnI increase and late elevation of CRP , suggesting that systemic inflammation may partially be a consequence of myocardial injury BACKGROUND The clinical significance of biochemical markers of myocardial damage or inflammation has not been prospect ively established in population s representing the whole spectrum of acute coronary syndromes . We investigated whether the elevation of these biomarkers at admission has a prognostic value that is independent and incremental to baseline clinical variables and quantitative electrocardiographic ischemia . METHODS We measured blood levels of cardiac troponin I ( cTnI ) and C-reactive protein ( CRP ) in 1773 consecutive patients admitted to 31 Italian coronary care units within 12 hours from an episode of acute coronary syndrome . Primary and secondary outcomes were ( 1 ) 30-day incidence of death or nonfatal (re)infa rct ion and ( 2 ) death alone . RESULTS In a multivariate model , cTnI was independently associated with the risk of death or (re)infa rct ion ( OR , 1.8 ; 95 % CI , 1.2 to 2.6 ; P = .002 ) and death ( OR , 2.2 ; 95 % CI , 1.4 to 3.4 ; P < .001 ) , whereas CRP was of borderline significance for the primary outcome but was associated with death ( OR , 1.4 ; 95 % CI , 1.0 to 2.1 ; P = .06 , and OR , 1.7 ; 95 % CI , 1.1 to 2.6 ; P = .01 , respectively ) . However , the inclusion of the biomarkers did not increase the prognostic capacity of the clinical risk model ( C-index of both models with and without biomarkers was 0.73 for the primary outcome measures and 0.80 for the secondary outcome measures ) . CRP further stratified cTnI-negative patients . The prognostic significance of the biomarkers was similar in patients with and in those without persistent ST-segment elevation . CONCLUSIONS In acute coronary syndromes , the elevation of cTnI and CRP at admission has an independent prognostic value that is not incremental to baseline clinical variables and quantitative electrocardiographic ischemia BACKGROUND Prospect i ve studies have shown that C-reactive protein ( CRP ) can be used to predict risk of future cardiovascular events . High-sensitivity methods for CRP ( hs-CRP ) measurement are needed for this purpose . METHODS We compared the clinical efficacy of an automated and commercially available latex-enhanced assay ( Latex ) for hs-CRP ( Dade Behring ) to a vali date d in-house ELISA , previously shown to predict future peripheral arterial disease ( PAD ) in asymptomatic population s. Using a prospect i ve , nested , case-control design , we measured baseline hs-CRP concentrations in 144 apparently healthy men who subsequently developed symptomatic PAD and 144 age- and smoking habit-matched controls who remained free of vascular disease over the follow-up period of 60 months . RESULTS The two hs-CRP assays correlated highly ( r = 0.95 ; P < 0.001 ) , and all but two participants were classified into concordant quartiles or varied by only one quartile . The median hs-CRP of the case group was significantly higher than that of controls when measured by either the ELISA ( 1.34 vs 0.99 mg/L ; P = 0.034 ) or the Latex method ( 1.80 vs 1.20 mg/L ; P = 0.042 ) . Furthermore , for both ELISA and the Latex method , the calculated relative risks of developing PAD increased significantly with each increasing quartile of hs-CRP . The calculated interquartile increase in relative risk of PAD was 31 % ( 95 % confidence interval , 5.2 - 62.2 % ; P = 0.01 ) for ELISA and 34 % ( 95 % confidence interval , 8.2 - 66.1 % ; P = 0.007 ) for the Latex method . CONCLUSIONS Our findings indicate that the Latex method is equally as efficacious as the vali date d ELISA in classifying patients into cutoff points established by prospect i ve studies for risk stratification for coronary and cerebrovascular disease C-reactive protein , a reactant of the acute phase of inflammation , has been shown to be increased in patients with unstable angina . Moreover , it has recently been found that increased C-reactive protein is associated with a poor outcome during hospitalization in selected patients with severe unstable angina . The aim of this study was to investigate the prognostic value of C-reactive protein elevation in a large population with unstable angina . We measured serum  levels  of this marker in 140 patients hospitalized with unstable angina ( class IIIB of the Braunwald classification , mean time from last anginal episode 5 + /- 5 hours ) . Thirty-nine of them ( 28 % ) had increased serum levels on hospital admission and 33 ( 24 % ) experienced an adverse outcome ( myocardial infa rct ion or refractory angina ) during hospitalization . Kaplan-Meier analysis showed that the probability of developing cardiac events during hospitalization was not different between patients with and without abnormal C-reactive protein levels . Furthermore , the incidence of ischemia at Holter monitoring during the first 72 hours after hospitalization was not different between patients with and without abnormal C-reactive protein . In a representative population of patients with unstable angina , a sizable proportion had increased serum C-reactive protein levels ; however , abnormal concentrations of C-reactive protein do not predict an adverse outcome in the early phase after the acute episode BACKGROUND In patients with unstable coronary artery disease , there is a relation between the short-term risk of death and blood levels of troponin  T ( a marker of myocardial damage ) and C-reactive protein and fibrinogen ( markers of inflammation ) . Using information obtained during an extension of the follow-up period in the Fragmin during Instability in Coronary Artery Disease trial , we evaluated the usefulness of troponin T , C-reactive protein , and fibrinogen levels and other indicators of risk as predictors of the long-term risk of death from cardiac causes . METHODS Levels of C-reactive protein and fibrinogen at enrollment and the maximal level of troponin T during the first 24 hours after enrollment were analyzed in 917 patients included in a clinical trial of low-molecular-weight heparin in unstable coronary artery disease . The patients were followed for a mean of 37.0 months ( range , 1.6 to 50.6 ) . RESULTS During follow-up , 1.2 percent of the 173 patients with maximal blood troponin T levels of less than 0.06 microg per liter died of cardiac causes , as compared with 8.7 percent of the 367 patients with levels of 0.06 to 0.59 microg per liter and 15.4 percent of the 377 patients with levels of at least 0.60 microg per liter ( P=0.007 and P=0.001 , respectively ) . The rates of death from cardiac causes were 5.7 percent among the 314 patients with blood C-reactive protein levels of less than 2 mg per liter , 7.8 percent among the 294 with levels of 2 to 10 mg per liter , and 16.5 percent among the 309 with levels of more than 10 mg per liter ( P=0.29 and P=0.001 , respectively ) . The rates of death from cardiac causes were 5.4 percent among the 314 patients with blood fibrinogen levels of less than 3.4 g per liter , 12.0 percent among the 300 with levels of 3.4 to 3.9 g per liter , and 12.9 percent among the 303 with levels of at least 4.0 g per liter ( P=0.004 and P=0.69 , respectively ) . In a multivariate analysis , levels of troponin T and C-reactive protein were independent predictors of the risk of death from cardiac causes . CONCLUSIONS In unstable coronary artery disease , elevated levels of troponin T and C-reactive protein are strongly related to the long-term risk of death from cardiac causes . These markers are independent risk factors , and their effects are additive with respect to each other and other clinical indicators of risk Background —This study sought to evaluate the predictive value of C-reactive protein ( CRP ) on long-term mortality in non – ST-elevation acute coronary syndromes ( NSTACS ) that were treated with a very early aggressive revascularization strategy . Methods and Results —We conducted a prospect i ve cohort study in 1042 consecutive patients with NSTACS who were undergoing coronary angiography and subsequent coronary stenting of the culprit lesion as the primary revascularization strategy within 24 hours . Levels of CRP were determined on admission . The patients were followed for a mean of 20 months . In-hospital mortality was significantly higher in patients with a CRP>10 mg/L ( 3.7 % versus 1.2 % with CRP<3 mg/L and versus 0.8 % with CRP of 3 to 10 mg/L ; relative risk for CRP>10 mg/L compared with CRP≤10 mg/L was 4.2 , 95 % confidence interval [ CI ] was 1.6 to 11.0;P = 0.004 ) . The increase in mortality in patients with CRP>10 mg/L persisted during follow-up . Long-term mortality was 3.4 % with CRP<3 mg/L , 4.4 % with CRP between 3 and 10 mg/L , and 12.7 % with CRP>10 mg/L ( relative risk for CRP>10 mg/L compared with CRP≤10 mg/L , 0.8 ; 95 % CI , 2.3 to 6.2;P < 0.001 ) . In addition , Kaplan-Meier survival analysis 
    Output:
    
In conclusion , the small number of assessment s of the incremental value of CRP  , in conjunction with controversial results regarding the independent predictive value of CRP for short-term events does not support the recommendation of the routine use of CRP for risk stratification at admission of patients with ACS