High residual inflammatory risk, low LDL-C linked to higher death, heart attack risk after PCI

It is very important to understand that inflammation does play a role in myocardial infarction is the message of a new study.

Persistent high residual inflammatory risk (defined as hsCRP >2 mg/l) and low LDL cholesterol (LDL-C) in patients undergoing percutaneous coronary intervention (PCI) is associated with a higher risk for major adverse cardiac and cerebrovascular events (death, heart attack and stroke), compared to patients with low hsCRP and LDL-C levels.

"Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI," write the authors. While there is not yet enough evidence to support hsCRP measurement in every PCI patient, authors would like to see it assessed more frequently in the future.

These are the results of a recent study published in the Journal of the American College of Cardiology.

Data on the impact of residual inflammatory risk (RIR) in patients undergoing PCI with baseline LDL-C ≤70 mg/dl are scarce. Roxana Mehran, MD, Mount Sinai Hospital, New York City, and colleagues conducted the study to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl.

In the study, which was a retrospective analysis of a prospective PCI registry from Mount Sinai Hospital, the researchers analyzed 22,799 patients who underwent PCI between January 2009 and December 2016 at their institution. They separated 3013 patients with persistent low (first low then low hsCRP), attenuated (first high then low hsCRP), increased (first low then high hsCRP), and persistent high RIR (first high then high hsCRP) in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively.

The primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement.

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They found that:

• Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years.


• After adjustment, the presence of persistent high RIR remained strongly associated with MACCE.

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Statins were used at baseline in 86.3% of all patients and were prescribed at discharge in 92.8%.

"After adjustment for possible confounders and using those with persistent low residual inflammatory risk as the reference groups, the presence of persistent high residual inflammation was associated with a 2.10-fold increased risk for MACCE," write the authors.

"Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI," concluded the authors.

For detailed study log on to DOI: 10.1016/j.jacc.2019.01.077