Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions

Kalkman, Deborah N.; Aquino, Melissa; Claessen, Bimmer E.; Baber, Usman; Guedeney, Paul; Sorrentino, Sabato; Vogel, Birgit; Winter, Robbert J. de; Sweeny, Joseph; Kovacic, Jason C.; Shah, Saleh; Vijay, Pooja; Barman, Nitin; Kini, Annapoorna; Sharma, Samin K.; Dangas, George

doi:10.1093/eurheartj/ehy633

Cited by 107 publications

(84 citation statements)

References 25 publications

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“…Recently, residual inflammatory risk (RIR) has been considered more important than before, because interventions to address inflammation could reduce CVD risk [15]. Kalkman et al showed that patients with persistent high RIR had higher all-cause mortality in patients undergoing percutaneous coronary intervention (PCI) at 1-year follow-up [16]. However, the long-term clinical impact of different patterns of RIR in stable CAD patients after PCI remains unclear for Asian populations.…”

Section: Introductionmentioning

confidence: 99%

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

Takahashi

Endo

Funamizu

et al. 2020

JCM

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The aim of this study was to investigate the long-term clinical impact of residual inflammatory risk (RIR) by evaluating serial high-sensitivity C-reactive protein (hs-CRP) in Asian patients with coronary artery disease (CAD). We evaluated 2032 patients with stable CAD undergoing percutaneous coronary intervention (PCI) with serial hs-CRP measurements (2 measurements, 6–9 months apart) from the period 2000 to 2016. A high-RIR was defined as hs-CRP > 0.9 mg/L according to the median value. Patients were assigned to four groups: persistent-high-RIR, increased-RIR, attenuated-RIR, or persistent-low-RIR. Major adverse cardiac events (MACE) and all-cause death were evaluated. MACE rates in patients with persistent high, increased and attenuated RIR were significantly higher than in patients with persistent low RIR (p < 0.001). Moreover, the rate of all-cause death was significantly higher among patients with persistent high and increased RIR than among patients with attenuated and persistent low RIR (p < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37–3.67, p = 0.001), increased RIR (HR 2.25, 95%CI 1.09–4.37, p = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14–3.32, p = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41–3.08, p < 0.001) and increased RIR (HR 1.94, 95%CI 1.07–3.36, p = 0.029) were predictive for all-cause death. A high RIR was significantly associated with MACE and all-cause death among Japanese CAD patients. An evaluation of changes in inflammation may carry important prognostic information and may guide the therapeutic approach.

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Section: Introductionmentioning

confidence: 99%

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

Takahashi

Endo

Funamizu

et al. 2020

JCM

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“…Inflammation is a major player in the pathogenesis of several human diseases. In this context, C‐reactive protein (CRP), the prototype human acute‐phase protein, has gained substantial interest . CRP has been suggested to play a key role in atherosclerosis , myocardial infarction , dilated cardiomyopathy , stroke , and potentially autoimmune disease .…”

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confidence: 99%

Selective C‐Reactive Protein‐Apheresis in Patients

Ries¹,

Heigl

Garlichs³

et al. 2019

Ther Apher Dial

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C‐reactive protein (CRP), the prototype human acute‐phase protein, is a well‐known marker of inflammation. However, CRP may also mediate tissue damage in various human diseases like atherosclerosis, acute myocardial infarction, dilated cardiomyopathy, stroke, and potentially autoimmune disease. Therefore, CRP elimination from human plasma may indeed be a widely usable therapeutic approach. Recently, a first‐in‐man case report of selective CRP‐apheresis in a patient with acute ST‐segment elevation myocardial infarction (STEMI) has been published. Here, the method is further elucidated by detailed description of 13 patients receiving CRP‐apheresis at two study centers. Thirteen patients received two sequential CRP‐apheresis treatments with the PentraSorb CRP adsorber starting 24 ± 12 h after STEMI and successful percutaneous coronary intervention (PCI). CRP was measured immediately before and after each treatment, and additionally twice a day for a period of 96 h after symptom onset. Compared to the initial (before‐treatment) CRP plasma concentration, CRP‐apheresis resulted in an average 53.4% ± 11.9% CRP depletion. First apheresis was performed 27.5 ± 4.6 h after symptom onset at a mean CRP concentration of 25.1 ± 11.1 mg/L. Mean CRP concentration after the first treatment was 12.1 ± 6.4 mg/L. Second apheresis started 47.9 ± 5.4 h after symptom onset at a mean CRP concentration of 30.2 ± 21.4 mg/L. After the second treatment, mean CRP concentration was reduced to 13.9 ± 10.9 mg/L. No severe apheresis‐associated side effects were observed. Patients tolerated selective CRP‐apheresis without any side effects. The new method is feasible and safe and significantly reduces CRP plasma concentration in humans.

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“…In a retrospective study of 7026 patients who underwent the pPCI procedure, Kalkman and colleagues estimated that 38% of patients who had hsCRP values ≥2 mg/l had a so-called persistent high residual inflammatory risk (RIR) which was associated with the highest all-cause mortality at one-year follow-up (2.6%) and the highest rate of myocardial infarction (7.5%) also at one-year follow-up (21). Therefore, the study by Kalkman et al (21) suggests that inflammation may be associated with the cardiovascular prognosis in patients who have undergone the pPCI procedure and who have also developed high hsCRP levels. By examining 118 patients with STEMI, Milano et al (22) also observed that higher levels of hsCRP at hospital admission were related to intra-hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Increased high sensitive C-reactive protein is associated with major adverse cardiovascular events after STEMI

Begić¹

2020

Erciyes Med J

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Objective: This study aims to investigate whether the high sensitive C-reactive protein (hsCRP) is associated with an ejection fraction of left ventricle (EFLV) in the early phase of ST-elevation myocardial infarction (STEMI), treated with the primary percutaneous intervention (pPCI), and to establish whether there exists a relationship between its values and the presence of major adverse cardiovascular events (MACE) within six months of pPCI. Materials and Methods:In this prospective study, 357 patients who were diagnosed with STEMI and who underwent pPCI within 24 hours of pain onset were included. The following were monitored and recorded: 1) hsCRP values, which were measured between 24 and 48 hours of pPCI, 2) EFLV values, which were measured five days after the pPCI, and 3) MACE, which was established within six months of pPCI. Results:The EFLV values measured five days after the pPCI were significantly lower with increasing hsCRP values (rho=-0.384, p<0.0001). There was a significant difference in hsCRP values between patients who had MACE and those without it (38.35 [98.10] vs. 12.97 [23.80], p=0.0001). In addition, hsCRP values were significantly increased in patients who died during the first six months after the pPCI compared with patients who survived (115.00 [202.80] vs. 15.84 [31.5], p=0.001). Conclusion:The hsCRP values in patients with STEMI who were treated with the pPCI are related to systolic function in the early phase of STEMI, as well as MACE during the first six months of follow-up.

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Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions

Cited by 107 publications

References 25 publications

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

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

Selective C‐Reactive Protein‐Apheresis in Patients

Increased high sensitive C-reactive protein is associated with major adverse cardiovascular events after STEMI

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