Key result
High residual inflammatory risk 30 days post-PCI linked to ~64% higher MACE risk.
Why the study?
Does high residual inflammatory risk increase the risk of major adverse cardiovascular events in patients undergoing contemporary PCI?
Meta-Analysis (n=13,604)
Does high residual inflammatory risk increase the risk of major adverse cardiovascular events in patients undergoing contemporary PCI?
Relative Risk: 1.64 (95% CI 1.33–2.03)
In patients undergoing contemporary PCI, high residual inflammatory risk (hsCRP ≥ 2 mg/L at 1 month) is associated with a significantly higher risk of MACE, mortality, MI, and stroke at 12 months.
Elevated low-density lipoprotein cholesterol (LDL-C) and subclinical inflammation - measured with high-sensitivity C-reactive protein (hsCRP) - contribute to atherosclerosis progression. Despite medical therapy, high-risk patients may still have residual cholesterol risk, residual inflammatory risk (RIR), both, or neither. We aimed to study the impact of RIR in patients undergoing contemporary percutaneous coronary intervention (PCI). A comprehensive search of Pubmed, EMBASE, Cochrane and MEDLINE was performed up to December 2024. Only studies including patients with coronary artery disease undergoing PCI were considered. Inflammatory burden was evaluated with two hs-CRP measurements at baseline and follow-up (> 4 weeks apart). High RIR was defined as hsCRP ≥ 2 mg/L at 1-month follow-up. The risk ratio (RR) with a 95% confidence interval (CI) was computed using a random-effect model. We identified five studies enrolling 13,604 patients, including 5,833 with high RIR at 30 days post–PCI. At 12-month follow-up, persistent high RIR was associated with an increased risk of major adverse cardiovascular events (MACE) (random-effects RR = 1.64, 95% CI 1.33–2.03; I² = 80.2%). High RIR was also associated with increased all-cause mortality (random-effects RR = 3.25, 95% CI 2.49–4.25; I² = 67%), non-fatal myocardial infarction (random-effects RR = 1.46, 95% CI 1.00–2.12; I² = 73%), and non-fatal stroke (random-effects RR = 1.64, 95% CI 1.14–2.37; I² = 0%). Sensitivity analyses, including Baujat plots and leave-one-out analyses, identified a single study as a major contributor to heterogeneity; exclusion of this study substantially reduced heterogeneity without materially altering the direction or magnitude of the associations. In patients undergoing contemporary PCI, a high RIR was associated with a significantly higher risk of adverse cardiovascular outcomes. This data could help tailor lipid-lowering and anti-inflammatory therapies in this high-risk population.
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Romeo et al. (2026) conducted a meta-analysis in Coronary artery disease undergoing PCI (n=13,604). High residual inflammatory risk (hsCRP ≥ 2 mg/L) vs. Low residual inflammatory risk was evaluated on Major adverse cardiovascular events (MACE) (RR 1.64, 95% CI 1.33-2.03). High residual inflammatory risk at 30 days post-PCI was associated with an increased risk of MACE at 12 months (RR 1.64; 95% CI 1.33-2.03).
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