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Inflammatory and Bleeding Risks on Clinical Outcomes in Acute Coronary Syndrome Patients Undergoing Percutaneous
Yixuan Duan1,2, Miaohan Qiu1, Kun Na1
1Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China.
Insights
Systemic inflammation, measured by high-sensitivity C-reactive protein (hsCRP), increases ischemic event and death risk in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). This association holds true regardless of bleeding risk status and does not predict bleeding events.
Area of Science:
- Cardiology
- Biomarkers
- Interventional Cardiology
Background:
- Systemic inflammation plays a role in acute coronary syndrome (ACS) pathophysiology.
- High-sensitivity C-reactive protein (hsCRP) is a marker of systemic inflammation.
- Bleeding risk stratification is crucial in ACS patients undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate the impact of systemic inflammation burden (hsCRP) on long-term prognosis in ACS patients post-PCI.
- To assess this impact stratified by high bleeding risk (HBR) status.
- To determine the relationship between hsCRP levels and both ischemic and bleeding events.
Main Methods:
- Analysis of 15,013 consecutive ACS patients who underwent PCI (March 2016 - March 2022).
- Systemic inflammation defined as hsCRP >2 mg/L; high bleeding risk defined by Academic Research Consortium (ARC)-HBR criteria.
- Primary outcome: ischemic events (cardiac death, myocardial infarction, stroke) at 12 months. Secondary outcomes: all-cause death and bleeding events (BARC types 2, 3, 5).
Main Results:
- Elevated hsCRP was associated with a higher risk of ischemic events in both HBR and non-HBR subgroups.
- An inverse J-shaped relation was observed between hsCRP and ischemic events/all-cause death in non-HBR patients.
- Elevated hsCRP was not associated with an increased risk of bleeding events, irrespective of HBR status.
Conclusions:
- High hsCRP levels indicate an increased risk of ischemic events and all-cause death in ACS patients post-PCI, independent of bleeding risk.
- hsCRP is a valuable prognostic marker for ischemic complications in ACS patients undergoing PCI.
- hsCRP levels do not appear to predict bleeding risk in this patient population.
Abstract:
This study aimed to evaluate the impact of systemic inflammation burden using high-sensitivity C-reactive protein (hsCRP) and long-term prognosis in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) stratified by bleeding risk status.Consecutive patients admitted for ACS and who received PCI between March 2016 and March 2022 were enrolled in the analysis. Elevated systemic inflammation was defined as hsCRP >2 mg/L, and high bleeding risk (HBR) was defined the Academic Research Consortium (ARC)-HBR criteria. The primary outcome was ischemic events at 12 months, composed of cardiac death, myocardial infarction, and/or stroke. The main secondary outcomes included all-cause death, and Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding and types 3 and 5 bleeding.Of 15,013 patients, 4,606 (30.7%) were qualified as HBR and 8,395 (55.9%) had hsCRP >2 mg/L. Elevated hsCRP was consistently associated with higher risk of ischemic events in both HBR (adjusted hazard ratio [aHR]: 1.20; 95% confidence interval [CI]: 0.91-1.58) and non-HBR (aHR: 1.34; 95% CI: 1.01-1.78) subgroups (P interaction = 0.755). Although the incidence of bleeding events was higher in HBR patients, an elevated hsCRP level was not associated with bleeding events regardless of HBR status. Restricted cubic spline regression represented an inverse J-shaped relation between hsCRP and non-HBR for ischemic events (P nonlinearity <0.001) and all-cause death (P nonlinearity = 0.003).Regardless of HBR status, high levels of hsCRP were associated with an increased risk of ischemic events and all-cause death in ACS patients following PCI, but not for bleeding.
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