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

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

Abstract

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.

Keywords: biomarker; coronary artery disease; hs-CRP; inflammation; percutaneous coronary intervention; residual risk.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Study flow chart. PCI, percutaneous coronary intervention; hs-CRP, high-sensitivity C-reactive protein; ACS, acute coronary syndrome; RIR, residual inflammatory risk.
Figure 2
Figure 2
Kaplan–Meier curve for major adverse cardiovascular events (MACE) and all-cause death. (A) Long-term major adverse cardiovascular events (MACE) (composite endpoint defined as cardiovascular death, non-fatal myocardial infarction, or non-fatal cerebral infarction). (B) Long-term all-cause mortality.

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