Residual inflammatory risk post STEMI: high prevalence despite LDL-C control and association with other secondary prevention targets

Background: Residual inflammation remains a major contributor to cardiovascular risk after ST-elevation myocardial infarction (STEMI), even with optimal control of traditional risk factors. This study evaluated the prevalence of residual inflammatory risk, using high-sensitivity C-reactive protein (hs-CRP) as a marker, and its association with achieving guideline-recommended secondary prevention targets following primary percutaneous coronary intervention (pPCI). Methods: We retrospectively analyzed 878 patients who underwent pPCI for STEMI between October 2016 and May 2023. At a mean of 2.4 years post-procedure, hs-CRP and secondary prevention metrics were assessed. Elevated hs-CRP level was defined as greater than 3 mg/L. Multivariable logistic regression was used to determine if there was an association between meeting these clinical targets and having lower hs-CRP levels. Results: The median hs-CRP level was 2.7 (IQR: 1.2-5), and 44.6% of patients had levels >3 mg/L. Achieving targets for waist circumference, LDL-C (<55 mg/dL), and triglycerides (<150 mg/dL), as well as adherence to statin and ACEI/ARB therapy, were independently associated with lower odds of elevated hs-CRP. Notably, 29.8% of patients with LDL-C < 55 mg/dL still exhibited elevated hs-CRP, indicating persistent inflammatory risk. Conclusion: Residual inflammatory risk is highly prevalent after STEMI, even among patients with optimal LDL-C control. Comprehensive secondary prevention-including lipid management, central obesity reduction, and medication adherence-correlates with lower hs-CRP. These findings underscore the need for strategies targeting inflammation alongside traditional risk factor control.