Key result
Persistent high residual inflammatory risk after PCI is linked to ~110% higher MACCE risk despite low LDL-C.
Why the study?
Does persistent high residual inflammatory risk increase the risk of MACCE in patients undergoing PCI with baseline LDL-C ≤70 mg/dl?
Cohort (n=3,013)
No
Does persistent high residual inflammatory risk increase the risk of MACCE in patients undergoing PCI with baseline LDL-C ≤70 mg/dl?
Hazard Ratio: 2.1 (95% CI 1.45–3.02)
Absolute Event Rate: 152.4% vs 64.4%
p-value: p=< 0.001
In patients undergoing PCI with optimal LDL-C control (≤70 mg/dl), persistent high residual inflammatory risk is common and independently associated with a twofold increased risk of MACCE at 1 year.
BACKGROUND Data on the impact of residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl are scarce. OBJECTIVES The purpose of this study was to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl. METHODS All patients undergoing PCI between January 2009 and December 2016 in a single tertiary center, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least 2 measurements ≥4 weeks apart) were retrospectively analyzed. High RIR was defined as hsCRP >2 mg/l. Patients were categorized as 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). Primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement. RESULTS A total of 3,013 patients were included, with persistent low, attenuated, increased, and persistent high RIR in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively. Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years; p < 0.001). After adjustment, the presence of persistent high RIR remained strongly associated with MACCE (adjusted hazard ratio: 2.10; 95% confidence interval: 1.45 to 3.02; p < 0.001). CONCLUSIONS Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.
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Guedeney et al. (2019) conducted a cohort in Patients undergoing PCI with baseline LDL-C ≤70 mg/dl (n=3,013). Persistent high residual inflammatory risk (hsCRP >2 mg/l) vs. Persistent low residual inflammatory risk was evaluated on Major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke) (HR 2.10, 95% CI 1.45 to 3.02, p=< 0.001). Persistent high residual inflammatory risk after PCI in patients with LDL-C ≤70 mg/dl increased the risk of MACCE compared to persistent low risk (HR 2.10; 95% CI 1.45-3.02; p<0.001).
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