Post-PCI Risk Assessment by Inflammation Activity According to Disease Acuity and Time from Procedure

Haegeun Song; Jong-Hwa Ahn; Min Gyu Kang; Kye-Hwan Kim; Jae Seok Bae; Sang Young Cho; Jin-Sin Koh; Yongwhi Park; Seok-Jae Hwang; Eun Jeong Cho; Kyeongmin Byeon; Sang-Wook Kim; Udaya S. Tantry; Paul A. Gurbel; Jin-Yong Hwang; Young-Hoon Jeong

doi:10.1055/a-2011-8426

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2023; 123(06): 627-640
DOI: 10.1055/a-2011-8426

Atherosclerosis and Ischaemic Disease

Post-PCI Risk Assessment by Inflammation Activity According to Disease Acuity and Time from Procedure

Haegeun Song

¹Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

²Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea

,

Jong-Hwa Ahn

³Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea

,

Min Gyu Kang

⁴Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea

⁵Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea

,

Kye-Hwan Kim

⁴Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea

⁵Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea

,

Jae Seok Bae

³Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea

,

Sang Young Cho

³Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea

,

Jin-Sin Koh

⁴Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea

⁵Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea

,

Yongwhi Park

³Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea

,

Seok-Jae Hwang

⁴Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea

⁵Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea

,

Eun Jeong Cho

¹Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

²Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea

,

Kyeongmin Byeon

¹Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

²Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea

,

Sang-Wook Kim

¹Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

²Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea

,

Udaya S. Tantry

⁶Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States

,

Paul A. Gurbel

⁶Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States

,

Jin-Yong Hwang

⁴Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea

⁵Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea

,

Young-Hoon Jeong

⁷CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea

⁸Department of Internal Medicine, Chung-Ang University School of Medicine, Gwangmyeong, South Korea

› Institutsangaben

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-CRP_baseline 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-CRP_baseline ≥ 2.4 mg/L) was associated with a greater MACE in the AMI group (adjusted hazard ratio [HR_adj]: 7.66; 95% confidence interval [CI]: 2.29–25.59; p < 0.001), but not in the non-AMI group (HR_adj: 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-CRP_{1 month} ≥ 1.6 mg/L) was associated with greater MACE compared to the other phenotype in both the AMI (HR_adj: 2.40; 95% CI: 1.73–3.45; p < 0.001) and non-AMI groups (HR_adj: 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-CRP_baseline 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.

Keywords

coronary artery disease - acute myocardial infarction - C-reactive protein

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Referenzen

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