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Residual Inflammatory Risk in Patients With Low LDL Cholesterol Levels Undergoing Percutaneous Coronary Intervention

Paul Guedeney1, Bimmer E Claessen2, Deborah N Kalkman3

  • 1Icahn School of Medicine at Mount Sinai Hospital, New York, New York; Sorbonne Université, ACTION Study Group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France.

Journal of the American College of Cardiology
|May 18, 2019
PubMed

Insights

Persistent high residual inflammatory risk (RIR) is common in patients after percutaneous coronary intervention (PCI) with optimal low-density lipoprotein cholesterol (LDL-C) levels. This elevated RIR significantly increases the risk of major adverse cardiac and cerebrovascular events (MACCE).

Area of Science:

  • Cardiology
  • Inflammation Research
  • Interventional Cardiology

Background:

  • Limited data exist on residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl.
  • Persistent inflammation after PCI may impact cardiovascular outcomes even with optimal LDL-C control.

Purpose of the Study:

  • To determine the prevalence of persistent high RIR in patients undergoing PCI with baseline LDL-C ≤70 mg/dl.
  • To assess the impact of persistent high RIR on major adverse cardiac and cerebrovascular accident (MACCE) rates in this patient population.

Main Methods:

  • Retrospective analysis of 3,013 patients undergoing PCI with baseline LDL-C ≤70 mg/dl and serial hsCRP measurements.
  • Patients were categorized based on RIR status: persistent low, attenuated, increased, or persistent high (defined as hsCRP >2 mg/l).
  • Primary endpoint was MACCE (death, myocardial infarction, stroke) within one year of the second hsCRP measurement.

Main Results:

  • Persistent high RIR was observed in 34.1% of patients.
  • A stepwise increase in MACCE incidence was noted across RIR categories, from persistent low to persistent high RIR (152.4 per 1,000 patient-years).
  • Persistent high RIR was independently associated with a 2.10-fold increased risk of MACCE (aHR: 2.10; 95% CI: 1.45 to 3.02; p < 0.001).

Conclusions:

  • Persistent high RIR is prevalent in patients with optimal LDL-C control post-PCI and significantly elevates MACCE risk.
  • Strategies targeting residual inflammation may offer a pathway to further enhance outcomes in patients following PCI.
Abstract

Keywords:
LDL-Cinflammationpercutaneous coronary intervention

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