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DOI: 10.1055/a-2011-8426
Post-PCI Risk Assessment by Inflammation Activity According to Disease Acuity and Time from Procedure
Funding This study was supported by the Science Research Program through the CAU Thrombosis and Biomarker Center of Korea funded by the Chung-Ang University Gwangmyeong Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies.
Abstract
Background High-sensitivity C-reactive protein (hs-CRP) has been proposed as an indicator of inflammation and cardiovascular risk. However, little is known of the comparative temporal profile of hs-CRP and its relation to outcomes according to the disease acuity.
Methods We enrolled 4,263 East Asian patients who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and stable disease. hs-CRP was measured at baseline and 1 month post-PCI. Major adverse cardiovascular events (MACE: the composite occurrence of death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years.
Result The AMI group (n = 2,376; 55.7%) had higher hs-CRPbaseline than the non-AMI group (n = 1,887; 44.3%) (median: 1.5 vs. 1.0 mg/L; p < 0.001), which remained higher at 1 month post-PCI (median: 1.0 vs. 0.9 mg/L; p = 0.001). During 1 month, a high inflammatory-risk phenotype (upper tertile: hs-CRPbaseline ≥ 2.4 mg/L) was associated with a greater MACE in the AMI group (adjusted hazard ratio [HRadj]: 7.66; 95% confidence interval [CI]: 2.29–25.59; p < 0.001), but not in the non-AMI group (HRadj: 0.74; 95% CI: 0.12–4.40; p = 0.736). Between 1 month and 4 years, a high inflammatory-risk phenotype (upper tertile: hs-CRP1 month ≥ 1.6 mg/L) was associated with greater MACE compared to the other phenotype in both the AMI (HRadj: 2.40; 95% CI: 1.73–3.45; p < 0.001) and non-AMI groups (HRadj: 2.67; 95% CI: 1.80–3.94; p < 0.001).
Conclusion AMI patients have greater inflammation during the early and late phases than non-AMI patients. Risk phenotype of hs-CRPbaseline correlates with 1-month outcomes only in AMI patients. However, the prognostic implications of this risk phenotype appears similar during the late phase, irrespective of the disease acuity.
REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04650529.
Publication History
Received: 21 August 2022
Accepted: 10 January 2023
Accepted Manuscript online:
12 January 2023
Article published online:
24 February 2023
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References
- 1 Libby P, Loscalzo J, Ridker PM. et al. Inflammation, immunity, and infection in atherothrombosis: JACC review topic of the week. J Am Coll Cardiol 2018; 72 (17) 2071-2081
- 2 Ridker PM, Everett BM, Thuren T. et al; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017; 377 (12) 1119-1131
- 3 Tardif J-C, Kouz S, Waters DD. et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med 2019; 381 (26) 2497-2505
- 4 Lawler PR, Bhatt DL, Godoy LC. et al. Targeting cardiovascular inflammation: next steps in clinical translation. Eur Heart J 2021; 42 (01) 113-131
- 5 Ridker PM. Residual inflammatory risk: addressing the obverse side of the atherosclerosis prevention coin. Eur Heart J 2016; 37 (22) 1720-1722
- 6 Kalkman DN, Aquino M, Claessen BE. et al. Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions. Eur Heart J 2018; 39 (46) 4101-4108
- 7 Ridker PM. A test in context: high-sensitivity C-reactive protein. J Am Coll Cardiol 2016; 67 (06) 712-723
- 8 James SK, Oldgren J, Lindbäck J, Johnston N, Siegbahn A, Wallentin L. An acute inflammatory reaction induced by myocardial damage is superimposed on a chronic inflammation in unstable coronary artery disease. Am Heart J 2005; 149 (04) 619-626
- 9 Kang DO, Park Y, Seo JH. et al; KAMIR-NIH Registry Investigators. Time-dependent prognostic effect of high sensitivity C-reactive protein with statin therapy in acute myocardial infarction. J Cardiol 2019; 74 (01) 74-83
- 10 Kim HK, Tantry US, Park H-W. et al. Ethnic difference of thrombogenicity in patients with cardiovascular disease: a pandora box to explain prognostic differences. Korean Circ J 2021; 51 (03) 202-221
- 11 Ahn JH, Tantry US, Kang MG. et al. Residual inflammatory risk and its association with events in east apan patients after coronary intervention. JACC Asia 2022; 2 (03) 323-337
- 12 Thygesen K, Alpert JS, Jaffe AS. et al; Executive Group on behalf of the Joint European Society of Cardiology (ESC)/American College of Cardiology (ACC)/American Heart Association (AHA)/World Heart Federation (WHF) Task Force for the Universal Definition of Myocardial Infarction. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72 (18) 2231-2264
- 13 Mehran R, Rao SV, Bhatt DL. et al. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 2011; 123 (23) 2736-2747
- 14 Sanderson NC, Parker WAE, Storey RF. Ticagrelor: clinical development and future potential. Rev Cardiovasc Med 2021; 22 (02) 373-394
- 15 He LP, Tang XY, Ling WH, Chen WQ, Chen YM. Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies. Heart 2010; 96 (05) 339-346
- 16 James SK, Armstrong P, Barnathan E. et al; GUSTO-IV-ACS Investigators. Troponin and C-reactive protein have different relations to subsequent mortality and myocardial infarction after acute coronary syndrome: a GUSTO-IV substudy. J Am Coll Cardiol 2003; 41 (06) 916-924
- 17 Oemrawsingh RM, Cheng JM, Akkerhuis KM. et al. High-sensitivity C-reactive protein predicts 10-year cardiovascular outcome after percutaneous coronary intervention. EuroIntervention 2016; 12 (03) 345-351
- 18 Schiele F, Meneveau N, Seronde MF. et al; Reseau de Cardiologie de Franche Comte. C-reactive protein improves risk prediction in patients with acute coronary syndromes. Eur Heart J 2010; 31 (03) 290-297
- 19 Kushner I, Broder ML, Karp D. Control of the acute phase response. Serum C-reactive protein kinetics after acute myocardial infarction. J Clin Invest 1978; 61 (02) 235-242
- 20 Arroyo-Espliguero R, Avanzas P, Cosín-Sales J, Aldama G, Pizzi C, Kaski JC. C-reactive protein elevation and disease activity in patients with coronary artery disease. Eur Heart J 2004; 25 (05) 401-408
- 21 Sabatine MS, Morrow DA, Jablonski KA. et al; PEACE Investigators. Prognostic significance of the Centers for Disease Control/American Heart Association high-sensitivity C-reactive protein cut points for cardiovascular and other outcomes in patients with stable coronary artery disease. Circulation 2007; 115 (12) 1528-1536
- 22 Takahashi N, Dohi T, Endo H. et al. Residual inflammation indicated by high-sensitivity C-reactive protein predicts worse long-term clinical outcomes in apanese patients after percutaneous coronary intervention. J Clin Med 2020; 9 (04) 1033
- 23 Bohula EA, Giugliano RP, Leiter LA. et al. Inflammatory and cholesterol risk in the FOURIER trial. Circulation 2018; 138 (02) 131-140
- 24 Held C, White HD, Stewart RAH. et al; STABILITY Investigators. Inflammatory biomarkers interleukin-6 and C-reactive protein and outcomes in stable coronary heart disease: experiences from the STABILITY (Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy) trial. J Am Heart Assoc 2017; 6 (10) e005077
- 25 Ridker PM, Rifai N, Pfeffer MA. et al; Cholesterol and Recurrent Events (CARE) Investigators. Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998; 98 (09) 839-844
- 26 Ridker PM, Cannon CP, Morrow D. et al; Pravastatin or Atorvastatin Evaluation and Infection Therapy-Thrombolysis in Myocardial Infarction 22 (PROVE IT-TIMI 22) Investigators. C-reactive protein levels and outcomes after statin therapy. N Engl J Med 2005; 352 (01) 20-28
- 27 Bohula EA, Giugliano RP, Cannon CP. et al. Achievement of dual low-density lipoprotein cholesterol and high-sensitivity C-reactive protein targets more frequent with the addition of ezetimibe to simvastatin and associated with better outcomes in IMPROVE-IT. Circulation 2015; 132 (13) 1224-1233
- 28 Klingenberg R, Aghlmandi S, Gencer B. et al. Residual inflammatory risk at 12 months after acute coronary syndromes is frequent and associated with combined adverse events. Atherosclerosis 2021; 320: 31-37
- 29 Bouabdallaoui N, Tardif JC, Waters DD. et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41 (42) 4092-4099
- 30 Nidorf SM, Fiolet ATL, Mosterd A. et al; LoDoCo2 Trial Investigators. Colchicine in patients with chronic coronary disease. N Engl J Med 2020; 383 (19) 1838-1847
- 31 Kim HK, Tantry US, Smith Jr SC. et al. The East Asian Paradox: an updated position statement on the challenges to the current antithrombotic strategy in patients with cardiovascular disease. Thromb Haemost 2021; 121 (04) 422-432
- 32 Kang J, Park KW, Palmerini T. et al. Racial differences in ischaemia/bleeding risk trade-off during anti-platelet therapy: individual patient level landmark meta-analysis from seven RCTs. Thromb Haemost 2019; 119 (01) 149-162
- 33 Golomb M, Redfors B, Crowley A. et al. Prognostic impact of race in patients undergoing PCI: analysis from 10 randomized coronary stent trials. JACC Cardiovasc Interv 2020; 13 (13) 1586-1595