Key result
High residual inflammatory risk linked to ~3.4-fold higher mortality after PCI despite optimal LDL-C.
Why the study?
The prognostic impact of high residual inflammatory risk in AMI patients treated with PCI who achieved optimal LDL-C control was unclear.
Does high residual inflammatory risk (hsCRP >2 mg/L) increase long-term mortality and MACCE in post-PCI acute myocardial infarction patients who have achieved optimal LDL-C control?
Cohort (n=661)
Yes
Does high residual inflammatory risk (hsCRP >2 mg/L) increase long-term mortality and MACCE in post-PCI acute myocardial infarction patients who have achieved optimal LDL-C control?
Hazard Ratio: 3.41 (95% CI 1.8–6.45)
Absolute Event Rate: 43.1% vs 10.9%
p-value: p=<0.001
Even with optimal LDL-C control (≤70 mg/dL) following PCI for acute myocardial infarction, a high residual inflammatory risk (hsCRP >2 mg/L) remains a strong independent predictor of long-term mortality and cardiovascular events.
High 1-year hsCRP flags elevated long-term risk despite optimal LDL-C post-AMI PCI; hypothesis-generating for anti-inflammatory trials, should not yet change practice.
BACKGROUND AND OBJECTIVES: This study aimed to evaluate the prognostic impact of high residual inflammatory risk (RIR) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) and achieved optimal low-density lipoprotein cholesterol (LDL-C) control. METHODS: A retrospective analysis was conducted on successfully revascularized AMI patients from a large, prospective, multi-center PCI registry between 2004 and 2014. Patients with LDL-C ≤70 mg/dL at 1-year follow up and serial high-sensitivity C-reactive protein (hsCRP) measurements at baseline and 1 year were included. High RIR was defined as hsCRP >2 mg/L at 1 year. The primary endpoint was all-cause mortality, and secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE). RESULTS: Of the 661 patients, 129 (19.5%) had high RIR. Over a median follow up of 5.3 years, the high RIR group had significantly higher mortality rates (43.1 per 1,000 patient-years) compared to the low RIR group (10.9 per 1,000 patient-years; p<0.001). After multivariable adjustment, high RIR remained independently associated with increased mortality (adjusted hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.80-6.45; p<0.001) and a higher risk of MACCE (adjusted HR, 3.08; 95% CI, 1.90-4.99; p<0.001). The associations between high RIR and adverse outcomes were also consistent in the subgroup with LDL-C ≤55 mg/dL. CONCLUSIONS: In stabilized AMI patients with optimal LDL-C control after PCI, high RIR is a significant prognostic factor for adverse events. Reducing residual inflammation may improve long-term outcomes following PCI in these patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02806102.
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Hyun et al. (2026) conducted a cohort in Acute Myocardial Infarction (n=661). High residual inflammatory risk (hsCRP >2 mg/L at 1 year) vs. Low residual inflammatory risk was evaluated on all-cause mortality (HR 3.41, 95% CI 1.80-6.45, p=<0.001). High residual inflammatory risk was associated with increased all-cause mortality in AMI patients with optimal LDL-C control after PCI (HR 3.41; 95% CI 1.80-6.45; p<0.001).
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