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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2531-3268
Blood Cells, Inflammation and Infection

Inflammatory and Bleeding Risks on Clinical Outcomes in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Yixuan Duan   *
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Miaohan Qiu   *
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Kun Na
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Daoshen Liu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Shangxun Zhou
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Ying Xu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Zizhao Qi
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Haiwei Liu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Kai Xu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Xiaozeng Wang
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Jing Li
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Yi Li
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Yaling Han
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
› Institutsangaben
Funding This work was supported by grants from the National Key Research and Development Program of China (2022YFC2503503 and 2022YFC2503504).
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Abstract

Objective

This study aimed to evaluate the impact of systemic inflammation burden using high-sensitivity C-reactive protein (hsCRP) and long-term prognosis in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) stratified by bleeding risk status.

Methods

Consecutive patients admitted for ACS and who received PCI between March 2016 and March 2022 were enrolled in the analysis. Elevated systemic inflammation was defined as hsCRP >2 mg/L, and high bleeding risk (HBR) was defined the Academic Research Consortium (ARC)-HBR criteria. The primary outcome was ischemic events at 12 months, composed of cardiac death, myocardial infarction, and/or stroke. The main secondary outcomes included all-cause death, and Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding and types 3 and 5 bleeding.

Results

Of 15,013 patients, 4,606 (30.7%) were qualified as HBR and 8,395 (55.9%) had hsCRP >2 mg/L. Elevated hsCRP was consistently associated with higher risk of ischemic events in both HBR (adjusted hazard ratio [aHR]: 1.20; 95% confidence interval [CI]: 0.91–1.58) and non-HBR (aHR: 1.34; 95% CI: 1.01–1.78) subgroups (P interaction = 0.755). Although the incidence of bleeding events was higher in HBR patients, an elevated hsCRP level was not associated with bleeding events regardless of HBR status. Restricted cubic spline regression represented an inverse J-shaped relation between hsCRP and non-HBR for ischemic events (P nonlinearity <0.001) and all-cause death (P nonlinearity = 0.003).

Conclusion

Regardless of HBR status, high levels of hsCRP were associated with an increased risk of ischemic events and all-cause death in ACS patients following PCI, but not for bleeding.

Keywords

acute coronary syndrome - high bleeding risk - high-sensitivity C-reactive protein - inflammation

Ethical Approval Statement

This study was approved by the institutional ethical committee of the General Hospital of Northern Theater Command with a waiver of the requirement to obtain informed consent. The study also complied with the provisions of the Declaration of Helsinki.


Data Availability Statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.


Authors' Contribution

D.Y.X. and M.H.Q. were responsible equally for writing the original draft, methodology, data curation, formal analysis, and visualization. K.N., D.S.L., S.X.Z., X.Y., Z.Z.Q., H.W.L., K.X., X.Z.W., and J.L. were responsible for the investigation. Y.L. was responsible for conceptualization, methodology, data curation, and project administration. Y.L.H. was responsible for conceptualization, funding acquisition, data curation, project administration, methodology, and supervision. All authors read and approved the final manuscript.


* These authors contributed equally to this work.


Supplementary Material



Publikationsverlauf

Eingereicht: 29. November 2024

Angenommen: 31. Januar 2025

Accepted Manuscript online:
04. Februar 2025

Artikel online veröffentlicht:
13. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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