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

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 hsCRP and relation to outcomes according to the disease acuity. Methods: We enrolled 4,263 patients who underwent percutaneous coronary intervention (PCI) for 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, MI, or stroke), and major bleeding were followed up to 4 years. Results: The AMI group (n=2,376, 55.7%) had higher hs-CRPbaseline than the non-AMI group (n=1,887, 44.3%) (median: 1.5 vs. 1.0 mg/L; P<0.001), that 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-CRPbaseline≥2.4 mg/L) was associated with a greater MACE in the AMI group (adjusted hazard ratio [HRadj]: 7.66; 95% confidence interval [CI]: 2.29-25.59; P<0.001), but not in the non-AMI group (HRadj: 0.74; 95% CI: 0.12-4.40; P=0.736). Between1-month and 4 years, a high inflammatory-risk phenotype (upper tertile: hs-CRP1-month≥1.6 mg/L) was associated with greater MACE compared to the other phenotype in both the AMI (HRadj: 2.40; 95% CI: 1.73-3.45; P<0.001) and non-AMI groups (HRadj: 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 hsCRPbaseline correlates with 1-month outcomes only in AMI patients. Whereas the prognostic implication of this risk phenotype appears similar during the late phase, irrespective of the disease acuity.