Persistent high residual inflammatory risk linked to MACCE in patients undergoing PCI
Persistent high residual inflammatory risk (RIR) is frequent in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl and appears to increase the risk of major adverse cardiac and cerebrovascular event (MACCE; ie, death, myocardial infarction or stroke), a recent study has shown.
Of the 3,013 patients included, 1,225 (41.7 percent) had persistent low RIR, 414 (13.7 percent) had attenuated RIR, 346 (11.5 percent) had increased RIR and 1,028 (34.1 percent) had persistent high RIR.
A stepwise increase was seen in the incidence rates of MACCE overall, transitioning from the persistent low to the attenuated, increased and persistent high RIR (64.4 vs 96.6 vs 138.0 vs 152.4 per 1,000 patient-years, respectively; p<0.001).
The robust association between the presence of persistent high RIR and MACCE persisted even after adjustment (adjusted hazard ratio, 2.10; 95 percent CI, 1.45–3.02; p<0.001).
“Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI,” the authors said.
This study retrospectively analysed all patients undergoing PCI between January 2009 and December 2016 in a single tertiary centre, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least two measurements ≥4 weeks apart).
High RIR was defined as hsCRP >2 mg/l. Patients were categorized as follows: persistent low RIR (first low then low hsCRP); attenuated RIR (first high then low hsCRP); increased RIR (first low then high hsCRP); or persistent high RIR (first high then high hsCRP). MACCE within 1 year of the second hsCRP measurement was the primary endpoint of interest.