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Thromb Haemost 2023; 123(06): 627-640
DOI: 10.1055/a-2011-8426
Atherosclerosis and Ischaemic Disease

Post-PCI Risk Assessment by Inflammation Activity According to Disease Acuity and Time from Procedure

Haegeun Song
1   Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
2   Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
,
Jong-Hwa Ahn
3   Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
,
Min Gyu Kang
4   Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
5   Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
,
Kye-Hwan Kim
4   Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
5   Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
,
Jae Seok Bae
3   Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
,
Sang Young Cho
3   Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
,
Jin-Sin Koh
4   Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
5   Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
,
Yongwhi Park
3   Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
,
Seok-Jae Hwang
4   Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
5   Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
,
Eun Jeong Cho
1   Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
2   Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
,
Kyeongmin Byeon
1   Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
2   Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
,
Sang-Wook Kim
1   Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
2   Department of Internal Medicine, Chung-Ang University College of Medicine, Gwangmyeong, South Korea
,
Udaya S. Tantry
6   Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
,
Paul A. Gurbel 
6   Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, United States
,
Jin-Yong Hwang
4   Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
5   Division of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
,
Young-Hoon Jeong 
7   CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
8   Department of Internal Medicine, Chung-Ang University School of Medicine, Gwangmyeong, South Korea
› Author Affiliations
Funding This study was supported by the Science Research Program through the CAU Thrombosis and Biomarker Center of Korea funded by the Chung-Ang University Gwangmyeong Hospital. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies.
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Abstract

Background High-sensitivity C-reactive protein (hs-CRP) has been proposed as an indicator of inflammation and cardiovascular risk. However, little is known of the comparative temporal profile of hs-CRP and its relation to outcomes according to the disease acuity.

Methods We enrolled 4,263 East Asian patients who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and stable disease. hs-CRP was measured at baseline and 1 month post-PCI. Major adverse cardiovascular events (MACE: the composite occurrence of death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years.

Result The AMI group (n = 2,376; 55.7%) had higher hs-CRPbaseline than the non-AMI group (n = 1,887; 44.3%) (median: 1.5 vs. 1.0 mg/L; p < 0.001), which remained higher at 1 month post-PCI (median: 1.0 vs. 0.9 mg/L; p = 0.001). During 1 month, a high inflammatory-risk phenotype (upper tertile: hs-CRPbaseline ≥ 2.4 mg/L) was associated with a greater MACE in the AMI group (adjusted hazard ratio [HRadj]: 7.66; 95% confidence interval [CI]: 2.29–25.59; p < 0.001), but not in the non-AMI group (HRadj: 0.74; 95% CI: 0.12–4.40; p = 0.736). Between 1 month and 4 years, a high inflammatory-risk phenotype (upper tertile: hs-CRP1 month ≥ 1.6 mg/L) was associated with greater MACE compared to the other phenotype in both the AMI (HRadj: 2.40; 95% CI: 1.73–3.45; p < 0.001) and non-AMI groups (HRadj: 2.67; 95% CI: 1.80–3.94; p < 0.001).

Conclusion AMI patients have greater inflammation during the early and late phases than non-AMI patients. Risk phenotype of hs-CRPbaseline correlates with 1-month outcomes only in AMI patients. However, the prognostic implications of this risk phenotype appears similar during the late phase, irrespective of the disease acuity.

Keywords

coronary artery disease - acute myocardial infarction - C-reactive protein

REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT04650529.


Supplementary Material



Publication History

Received: 21 August 2022

Accepted: 10 January 2023

Accepted Manuscript online:
12 January 2023

Article published online:
24 February 2023

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