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Effect of Elevated C-Reactive Protein on Outcomes After Complex Percutaneous Coronary Intervention for Angina
Anton Camaj1, Gennaro Giustino1, Nikola Kocovic1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York City, New York.
Insights
Elevated high-sensitivity C-reactive protein (hsCRP) indicates a higher risk of major adverse cardiac events (MACE) after percutaneous coronary intervention (PCI). This increased risk associated with inflammation is consistent, irrespective of PCI complexity.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Inflammation and procedural complexity are known risk factors for adverse outcomes post-percutaneous coronary intervention (PCI).
- High-sensitivity C-reactive protein (hsCRP) is a key inflammatory biomarker.
- Understanding the interplay between inflammation and PCI complexity is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between elevated hsCRP levels and adverse cardiovascular events in patients undergoing PCI.
- To determine if the impact of hsCRP on adverse events varies based on the complexity of the PCI procedure.
Main Methods:
- Retrospective analysis of 11,979 patients who underwent PCI between 2012 and 2017 with available hsCRP levels.
- Patients were categorized by hsCRP levels (≥3 mg/L vs. <3 mg/L) and PCI complexity (defined by multiple criteria).
- Primary endpoint was the 1-year incidence of major adverse cardiac events (MACE), a composite of death, myocardial infarction, or target vessel revascularization.
Main Results:
- The 1-year MACE incidence was higher in patients with high hsCRP (≥3 mg/L) across both noncomplex and complex PCI groups.
- Specifically, MACE rates were 6% (noncomplex, low hsCRP), 10% (noncomplex, high hsCRP), 10% (complex, low hsCRP), and 15% (complex, high hsCRP).
- Elevated hsCRP was independently associated with increased MACE risk, regardless of the number of complex PCI features (pinteraction = 0.42).
Conclusions:
- Elevated hsCRP is a significant predictor of increased ischemic events following PCI.
- The heightened cardiovascular risk associated with elevated hsCRP persists consistently, independent of the procedural complexity of PCI.
- hsCRP serves as a valuable biomarker for risk assessment in patients undergoing PCI.
Abstract:
Inflammation and procedural complexity are individually associated with adverse outcomes after percutaneous coronary intervention (PCI). We aimed to evaluate the association of high sensitivity C-reactive protein (hsCRP) with adverse events according to PCI complexity. We included patients with available hsCRP levels who underwent PCI at our center from 2012 to 2017. We compared patients with hsCRP ≥3 versus <3 mg/L. Complex PCI was defined as having ≥1 of the following: ≥3 different target vessels, ≥3 lesions treated, ≥3 stents implanted, bifurcation lesion treated with 2 stents, chronic total occlusion as target lesion, or total stent length >60 mm. The primary end point was major adverse cardiac events (MACEs) (composite of all-cause death, myocardial infarction, or target vessel revascularization) at 1 year. A total of 11,979 patients were included, of which 2,840 (24%) underwent complex PCI. In those, 767 (27%) had hsCRP ≥3 mg/L. The 1-year incidence of MACE was 6% (noncomplex PCI, low hsCRP), 10% (noncomplex PCI, high hsCRP), 10% (complex PCI, low hsCRP), and 15% (complex PCI, high hsCRP). Overall, hsCRP ≥3 mg/L was associated with an increased risk of MACE compared with hsCRP <3 mg/L; this was independent of the number of complex PCI features: 0 (adjusted hazard ratio [HR] 1.53; 95% confidence interval [CI] 1.27 to 1.86), 1 (adjusted HR 1.77; 95% CI 1.21 to 2.60), or ≥2 (adjusted HR 1.21; 95% CI 0.80 to 1.83) (pinteraction = 0.42). In conclusion, in patients who underwent PCI, elevated hsCRP is associated with an increased risk of ischemic events. The effect of elevated hsCRP on cardiovascular risk is consistent regardless of PCI complexity.
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