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

• Published in: Journal of clinical medicine 2020-04, Vol.9 (4), p.1033
• Main Authors: Takahashi, Norihito, Dohi, Tomotaka, Endo, Hirohisa, Funamizu, Takehiro, Wada, Hideki, Doi, Shinichiro, Kato, Yoshiteru, Ogita, Manabu, Okai, Iwao, Iwata, Hiroshi, Okazaki, Shinya, Isoda, Kikuo, Miyauchi, Katsumi, Shimada, Kazunori
• Format: Article
• Language: English
• Subjects: Acute coronary syndromes; Angioplasty; Body mass index; Cardiovascular disease; Clinical medicine; Coronary vessels; Diabetes; Heart attacks; Inflammation; Intervention; Kidney diseases; Medical imaging; Medical records; Mortality; Patients; Variance analysis; Vein & artery diseases
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm9041033

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 ( < 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 ( < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37-3.67, = 0.001), increased RIR (HR 2.25, 95%CI 1.09-4.37, = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14-3.32, = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41-3.08, < 0.001) and increased RIR (HR 1.94, 95%CI 1.07-3.36, = 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.