Residual Inflammation Indicated by High-Sensitivity C-Reactive Protein Predicts Worse Long-Term Clinical Outcomes in Japanese Patients after Percutaneous Coronary Intervention

Takahashi, Norihito; Endo, Hirohisa; Funamizu, Takehiro; Wada, Hideki; Kato, Yoshiteru; Ogita, Manabu; Okai, Iwao; Iwata, Hiroshi; Okazaki, Shinya; Isoda, Kikuo; Miyauchi, Katsumi; Shimada, Kazunori

doi:10.3390/jcm9041033

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…A recent analysis from Japan showed that a persistent high RIR phenotype (serial hsCRP measurements > 0.9 mg/L: baseline and 6-9 months apart) in patients with stable CAD was significantly associated with MACE at 5year follow-up (HR: 2.22; 95%: CI 1.37 to 3.67; P = 0.001). 22 In the present study after 1-month of the recommended medical therapy, the decrease in hsCRP level was greater in AMI vs. non AMI patients 4 . This finding may suggest that longterm prognosis past the acute phase in AMI patients can be more accurately predicted by hsCRP level at the late time point, rather than the index hsCRP level.…”

Section: Time-dependent Change Of Inflammation Status In Cad Patientssupporting

confidence: 41%

“…A recent analysis from Japan showed that a persistent high RIR phenotype (serial hs-CRP measurements >0.9 mg/L: baseline and 6–9 months apart) in patients with stable CAD was significantly associated with MACE at 5-year follow-up (HR: 2.22; 95%: CI 1.37–3.67; p = 0.001). 22…”

Section: Discussionmentioning

confidence: 99%

“…For example, our group showed 18.0% of persistent high RIR (serial hsCRP values ≥ 2 mg/L) in Korean patients 1 and Japanese data suggested 28.7% of this phenotype (serial hsCRP measures > 0.9 mg/L). 29 East Asians with persistent high RIR also had an increased risk of MACE including all-cause death.…”

Section: Accepted Manuscriptmentioning

confidence: 95%

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

et al. 2023

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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.

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Section: Time-dependent Change Of Inflammation Status In Cad Patientssupporting

confidence: 41%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…However, clinical studies have shown that a number of patients still have a residual risk for cardiovascular disease even after achieving the targeted cholesterol level 27. It has been documented that inflammation indicators play a dominant role in the poor prognosis of CAD in patients with a targeted LDL-C level 28 29. Therefore, residual inflammatory risk has gained much interest in patients with controlled cholesterol 30.…”

Section: Discussionmentioning

confidence: 99%

MHR and NHR but not LHR were associated with coronary artery disease in patients with chest pain with controlled LDL-C

Liu

Zhen

et al. 2022

Journal of Investigative Medicine

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Several leukocyte to high-density lipoprotein cholesterol (HDL-C) ratios, including monocyte to HDL-C ratio (MHR), neutrophil to HDL-C ratio (NHR) and lymphocyte to HDL-C ratio (LHR), have been proposed as novel inflammatory indicators. We performed a cross-sectional study to investigate the relationships between these leukocyte to HDL-C ratios and coronary artery disease (CAD) in patients with chest pain with controlled low-density lipoprotein cholesterol (LDL-C). A total of 3482 patients with chest pain with LDL-C <1.8 mmol/L were enrolled. We evaluated the relationships between MHR, NHR, LHR and HDL-C and the occurrence of CAD as well as severe stenosis. We found that in patients with chest pain, higher MHR (adjusted OR=2.83, 95% CI 1.61 to 4.99, p<0.001) and NHR (adjusted OR=1.08, 95% CI 1.04 to 1.13, p<0.001), as well as lower HDL-C (adjusted OR=0.53, 95% CI 0.36 to 0.78, p=0.001), but not higher LHR (adjusted OR=1.06, 95% CI 0.94 to 1.20, p=0.341), had a stronger association with the occurrence of CAD. Moreover, unlike LHR (adjusted OR=1.02, 95% CI 0.93 to 1.13, p=0.654), higher MHR (adjusted OR=2.10, 95% CI 1.43 to 3.07, p<0.001) and NHR (adjusted OR=1.06, 95% CI 1.04 to 1.09, p<0.001) and lower HDL-C (adjusted OR=0.38, 95% CI 0.26 to 0.56, p<0.001) were risk factors for severe stenosis. A receiver operating characteristic curve analysis exhibited comparable abilities between MHR and NHR in predicting the presence and severity of CAD. In conclusion, even though patients with chest pain have achieved LDL-C <1.8 mmol/L, the inflammatory indicators MHR and NHR maintained their predictive abilities and remained associated with the occurrence and severity of CAD.

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“…For patients with acute myocardial infarction (AMI) undergoing PCI, inflammatory response plays a pivotal role in the whole pathophysiological process. Since inflammation can promote endothelial cell injury ( 4 ), vascular remodeling ( 5 ), and plaque destabilization ( 6 ), it is now regarded as another risk factor for AMI besides traditionally acknowledged risk factors like hypertension and dyslipidemia ( 7 ). In addition, the pro-inflammatory response occurs in the early stage of AMI and may exacerbate after PCI, thus contributing to the death of myocardial cells ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of C-reactive protein as predictor of adverse prognosis in acute myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis from 18,715 individuals

Liu

Jiang

Dhuromsingh

et al. 2022

Front. Cardiovasc. Med.

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BackgroundProper prognostic biomarker is of great importance for clinical decision-making in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). Although recently emerges plenty of novel inflammatory biomarkers, the canonical inflammatory mediator C-reactive protein still plays an important role in prognosing adverse post-infarction complications.MethodsPubMed, Embase, and Medline were systematically searched from the establishment of databases up to December 2021, conforming with standards set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsA total of 23 studies were eventually eligible for this meta-analysis, including 18,715 individuals. Our findings showed that elevated C-reactive protein (CRP) had a statistically significant superiority in predicting all-cause mortality (OR: 3.22, 95% CI: [2.71, 3.84], p < 0.00001), cardiovascular death (OR: 3.26, 95% CI: [2.30, 4.61], p < 0.00001), major adverse cardiovascular events (MACEs) (OR: 2.85, 95% CI [2.08, 3.90], p < 0.00001), heart failure (OR: 2.29, 95% CI: [1.48, 3.54], p = 0.0002), recurrent myocardial infarction (OR: 1.76, 95% CI: [1.28, 2.43], p < 0.001), and restenosis (OR: 1.71, 95% CI: [1.18, 2.47], p = 0.004). Subgroup analysis implies that CRP had better performance in predicting plenty of hospitalization and short-term (<12 months) adverse prognosis than long-term prognosis and Asian patients with elevated CRP were under more risk in adverse prognosis after PCI than Europeans.ConclusionOur meta-analysis suggests that CRP is a prospective predictor of the prognosis in patients with AMI undergoing PCI, especially in hospitalization and short-term and in the Asian group.

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Residual Inflammation Indicated by High-Sensitivity C-Reactive Protein Predicts Worse Long-Term Clinical Outcomes in Japanese Patients after Percutaneous Coronary Intervention

Cited by 4 publications

References 38 publications

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

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

MHR and NHR but not LHR were associated with coronary artery disease in patients with chest pain with controlled LDL-C

Evaluation of C-reactive protein as predictor of adverse prognosis in acute myocardial infarction after percutaneous coronary intervention: A systematic review and meta-analysis from 18,715 individuals

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