Residual Inflammatory Risk and its Association With Events in East Asian Patients After Coronary Intervention

Jong-Hwa Ahn, Udaya S Tantry, Min Gyu Kang, Hyun Woong Park, Jin-Sin Koh, Jae Seok Bae, Sang Young Cho, Kye-Hwan Kim, Jeong Yoon Jang, Jeong Rang Park, Yongwhi Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang, Paul A Gurbel, Young-Hoon Jeong, Jong-Hwa Ahn, Udaya S Tantry, Min Gyu Kang, Hyun Woong Park, Jin-Sin Koh, Jae Seok Bae, Sang Young Cho, Kye-Hwan Kim, Jeong Yoon Jang, Jeong Rang Park, Yongwhi Park, Seok-Jae Hwang, Choong Hwan Kwak, Jin-Yong Hwang, Paul A Gurbel, Young-Hoon Jeong

Abstract

Background: East Asian population has a low level of inflammation compared with Western population. The prognostic implication of residual inflammatory risk (RIR) remains uncertain in East Asians.

Objectives: This study sought to provide an analysis to estimate early-determined RIR and its association with clinical outcomes in East Asian patients with coronary artery disease (CAD).

Methods: In an East Asian registry including patients with CAD undergoing percutaneous coronary intervention (PCI) (n = 4,562), RIR status was determined by measuring high-sensitivity C-reactive protein (hsCRP) serially at admission and at 1-month follow-up. Patients were stratified into 4 groups according to hsCRP criteria (≥2 mg/L): 1) persistent low RIR (lowon admission-low1 month: 51.0%); 2) fortified RIR (lowon admission-high 1 month: 10.3%); 3) attenuated RIR (highon admission-low1 month: 20.5%); and 4) persistent high RIR (highon admission-high1 month: 18.3%). The risks of all-cause death, ischemic events, and major bleeding were evaluated.

Results: In our cohort, median levels of hsCRP were significantly decreased over time (1.3 to 0.9 mg/L; P < 0.001). Compared with hsCRP on admission, hsCRP at 1 month showed the greater associations with all-cause death and ischemic event. During clinical follow-up, risks of clinical events were significantly different across the groups (log-rank test, P < 0.001). Compared with other RIR groups, persistent high RIR showed the higher risk for all-cause death (HRadjusted, 1.92; 95% CI: 1.44 to 2.55; P < 0.001), ischemic events (HRadjusted, 1.26; 95% CI: 1.02 to 1.56; P = 0.032), and major bleeding (HRadjusted, 1.98; 95% CI: 1.30 to 2.99; P < 0.001), respectively.

Conclusions: Approximately one-fifth of East Asian patients with CAD have persistent high RIR, which shows the close association with occurrence of ischemic and bleeding events. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).

Keywords: AMI, acute myocardial infarction; ASCVD, atherosclerotic cardiovascular disease; C-reactive protein; CAD, coronary artery disease; CKD, chronic kidney disease; East Asian; LDL-C, low-density lipoprotein cholesterol; MACE, major adverse cardiovascular events; PCI, percutaneous coronary intervention; RIR, residual inflammatory risk; coronary artery disease; hsCRP, high sensitivity C-reactive protein; residual inflammation.

Conflict of interest statement

This study was supported by research grants from the Basic Science Research Program through the National Research Foundation (NRF) of Korea, funded by the Ministry of Science, ICT, and Future Planning (NRF-2015R1A5A2008833). Dr Gurbel has received grants and personal fees from Bayer HealthCare LLC, Amgen, Janssen, U.S. WorldMeds LLC, and Otitopic Inc; grants from Instrumentation Laboratory, Hikari Dx, Haemonetics, Medicure Inc., and Idorsia Pharmaceuticals; personal fees from Up-To-Date outside the submitted work; in addition, Dr Gurbel holds patents for Detection of Restenosis Risk in Patients and and Assessment of Cardiac Health and Thrombotic Risk in a Patient. Dr Jeong has received honoraria for lectures from AstraZeneca, Daiichi Sankyo, Sanofi-Aventis, Han-mi Pharmaceuticals, and Yuhan Pharmaceuticals and research grants or support from Yuhan Pharmaceuticals and U&I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper.

© 2022 The Authors.

Figures

Graphical abstract
Graphical abstract
Figure 1
Figure 1
Study Flow Diagram hsCRP = high-sensitivity C-reactive protein; PCI = percutaneous coronary intervention; RIR = residual inflammatory risk.
Figure 2
Figure 2
Kaplan-Meier Curves for Adverse Clinical Events, According to hsCRP Criteria at on Admission and at 1 Month Major adverse cardiovascular event (MACE) included cardiovascular (CV) death, myocardial infarction (MI), and cerebrovascular accident (CVA). Abbreviations as in Figure 1.
Figure 3
Figure 3
Kaplan-Meier Curves for Adverse Clinical Events, Stratified by Phenotype of Residual Inflammatory Risk Abbreviations as in Figure 1.
Figure 4
Figure 4
Kaplan-Meier Curves for Adverse Clinical Events Between Persistent High RIR vs Other RIRs Abbreviations as in Figure 1.
Figure 5
Figure 5
Comparative Hazard Ratios of Adverse Clinical Events Across Subgroups CKD = chronic kidney disease; DM = diabetes mellitus; other abbreviations as in Figures 1 and 2.
Figure 5
Figure 5
Comparative Hazard Ratios of Adverse Clinical Events Across Subgroups CKD = chronic kidney disease; DM = diabetes mellitus; other abbreviations as in Figures 1 and 2.
Central Illustration
Central Illustration
Prognostic Implications According to Phenotype of Residual Inflammatory Risk in PCI-Treated Patients Residual inflammatory risk (RIR) was determined by serial measurements of high-sensitivity C-reactive protein (hsCRP) at on-admission and 1-month follow-up. Compared with American cohort (Mount Sinai Hospital registry), East Asian cohort (GNUH registry) had a lower prevalence of persistent high RIR (18.3% vs 36.5%). Compared with other RIR phenotypes, persistent high RIR phenotype showed higher risks of all-cause death and major bleeding in patients undergoing percutaneous coronary intervention (PCI). MACE = major adverse cardiovascular events.

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Source: PubMed

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