Related Experiment Video
Updated: Jul 3, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Impact of Bleeding Risk and Inflammation on Cardiovascular Outcomes After Percutaneous Coronary Intervention
Manish Vinayak1, Davide Cao2, Richard Tanner1
1The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Insights
Elevated high-sensitivity C-reactive protein (hsCRP) indicates a higher risk of adverse cardiovascular events after percutaneous coronary intervention (PCI), regardless of bleeding risk. hsCRP levels did not predict bleeding complications in patients undergoing PCI.
Area of Science:
- Cardiology
- Inflammation Research
- Interventional Cardiology
Background:
- Systemic inflammation markers like high-sensitivity C-reactive protein (hsCRP) are linked to adverse cardiovascular events post-percutaneous coronary intervention (PCI).
- The influence of high bleeding risk (HBR) on the association between hsCRP and cardiovascular outcomes after PCI remains unclear.
Purpose of the Study:
- To investigate the impact of hsCRP levels on cardiovascular outcomes in patients undergoing PCI.
- To stratify outcomes based on the presence or absence of high bleeding risk (HBR) conditions.
Main Methods:
- A cohort of 15,150 patients undergoing PCI between 2012 and 2019 with baseline hsCRP measurements were analyzed.
- High hsCRP was defined as >3 mg/L; HBR was determined using Academic Research Consortium criteria.
- The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE) at 1 year; bleeding events were secondary outcomes.
Main Results:
- Patients with high hsCRP exhibited a consistently higher risk of MACCE, both in HBR (aHR: 1.49) and non-HBR (aHR: 1.87) subgroups, with no significant interaction.
- While bleeding risk was higher in the HBR cohort, hsCRP levels did not predict bleeding events in either HBR (aHR: 1.04) or non-HBR (aHR: 0.99) groups.
- No significant interaction was observed between HBR status and hsCRP levels for either MACCE or bleeding outcomes.
Conclusions:
- Elevated hsCRP levels at the time of PCI are associated with an increased risk of ischemic events.
- This association between hsCRP and ischemic risk persists irrespective of a patient's high bleeding risk status.
- hsCRP does not appear to be a predictor of bleeding complications in patients undergoing PCI.
Background:
Markers of systemic inflammation, such as high-sensitivity C-reactive protein (hsCRP), have been associated with the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in patients undergoing percutaneous coronary intervention (PCI). Whether this risk varies according to the presence of high bleeding risk (HBR) conditions is unclear.
Objectives:
The aim of this study was to evaluate the impact of systemic inflammation, as measured by hsCRP levels and cardiovascular outcomes in patients stratified by HBR status following PCI.
Methods:
Consecutive patients undergoing PCI between 2012 and 2019 with baseline hsCRP levels were included. High hsCRP was defined as >3 mg/L, and HBR was defined per the Academic Research Consortium HBR criteria. The primary outcome was MACCE, including all-cause death, myocardial infarction, or stroke at 1 year. All bleeding was assessed as a secondary outcome.
Results:
A total of 15,150 patients were included, and 40.4% (n = 6,125) qualified as HBR. The adjusted risk for MACCE was consistently higher in patients with high hsCRP in both HBR (adjusted HR [aHR]: 1.49; 95% CI: 1.18-1.87) and non-HBR (aHR: 1.87; 95% CI: 1.31-2.66) subgroups, with no interaction between HBR status and hsCRP level (Pinteraction = 0.26). Conversely, although bleeding risk was higher in the HBR cohort, hsCRP did not predict the occurrence of bleeding in either the HBR (aHR: 1.04; 95% CI: 0.82-1.31) or the non-HBR (aHR: 0.99; 95% CI: 0.71-1.39) subgroup (Pinteraction = 0.539).
Conclusions:
Elevated hsCRP at the time of PCI is associated with a higher risk for ischemic but not bleeding events, irrespective of HBR status.
More Related Videos
Related Concept Videos
01:20Extrinsic and Intrinsic Pathways of Hemostasis
The Extrinsic Pathway
The extrinsic pathway of coagulation is typically initiated by tissue damage that exposes blood to tissue factor (TF), a protein released by the damaged tissue cells outside the blood vessels—this interaction with TF triggers biochemical reactions involving specific clotting factors. The key player here is Factor VII, which...
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...
01:24Disorders of Hemostasis
Thromboembolic Disorders
Two factors primarily cause thromboembolic conditions.
01:05Introduction to Hemostasis
The three phases of hemostasis involve many clotting factors present in plasma and several substances released by platelets and injured tissue cells. It is a fast, localized,...
01:38Inflammation
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...