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Prognostic role of CRP-independent inflammatory patterns in patients undergoing primary percutaneous interventions

Filippo Dossi1,2, Mario Raccis1,2, Guido Parodi1,2

  • 1Department of Medicine, Cardiology Unit, Lavagna Hospital, Lavagna, Italy.

European Journal of Clinical Investigation
|April 8, 2023
PubMed

Insights

Elevated or increasing Systemic Immune-Inflammatory Index (SII) patterns, independent of C-reactive protein (CRP), predict worse outcomes in acute coronary syndrome patients after primary percutaneous coronary intervention (pPCI). These inflammatory patterns identify high-risk individuals for adverse events within one year.

Area of Science:

  • Cardiology
  • Immunology
  • Inflammation Research

Background:

  • Inflammation plays a critical role in coronary artery disease (CAD) pathogenesis.
  • Assessing inflammatory status in acute coronary syndrome (ACS) patients remains challenging.
  • This study investigates CRP-independent inflammatory patterns in ACS patients undergoing primary PCI.

Purpose of the Study:

  • To evaluate the prevalence of distinct CRP-independent inflammatory patterns in patients undergoing primary PCI.
  • To determine the one-year association between these inflammatory patterns and adverse clinical outcomes.
  • To identify novel prognostic markers for risk stratification in ACS.

Main Methods:

  • An observational, single-centre study included 2353 patients with ST-segment elevation myocardial infarction (STEMI) treated with primary PCI.
  • Systemic Immune-Inflammatory Index (SII) was calculated at admission and discharge.
  • Patients were categorized into four SII trajectory patterns: 'persistent-low', 'down-sloping', 'up-sloping', and 'persistent-high'.

Main Results:

  • The prevalence of SII patterns was: 'persistent-low' (44%), 'down-sloping' (31%), 'up-sloping' (4%), and 'persistent-high' (21%).
  • One-year adverse event rates were: 'persistent-low' (8%), 'down-sloping' (12%), 'up-sloping' (27%), and 'persistent-high' (25%).
  • 'Up-sloping' (OR: 3.2) and 'persistent-high' (OR: 4.1) SII patterns were independent predictors of one-year adverse events.

Conclusions:

  • 'Persistent-high' and 'up-sloping' CRP-independent inflammatory patterns are linked to increased adverse events post-primary PCI.
  • These SII patterns offer prognostic value for identifying high-risk patients.
  • Individualized therapeutic strategies may benefit from considering these inflammatory patterns.
Abstract

Keywords:
CRPindividualized medicineprimary PCIprognosissystemic inflammationtailored medicine

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