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Routinely Available Inflammatory Biomarkers Are Not Associated With Target Lesion Revascularization After Coronary
Eva Steinacher1, Andreas Hammer1, Ulrike Baumer1
1Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Insights
Systemic inflammation predicts mortality after percutaneous coronary intervention (PCI), but not target lesion revascularization or stent thrombosis. Elevated inflammatory markers should not delay PCI with modern stents.
Area of Science:
- Cardiology
- Inflammation Research
- Interventional Cardiology
Background:
- Biomarkers of inflammation predict adverse cardiovascular events in coronary artery disease.
- The link between systemic inflammation and percutaneous coronary intervention (PCI)-related adverse events is unclear.
Purpose of the Study:
- To investigate the association of C-reactive protein, leukocytes, and neutrophil-to-lymphocyte ratio (NLR) with patient outcomes after PCI.
- To determine if inflammatory biomarkers predict PCI-related adverse events in an unselected patient cohort.
Main Methods:
- Observational trial of 7,412 patients undergoing PCI.
- Median follow-up of 4.6 years.
- Primary endpoints: target lesion revascularization (TLR) and acute stent thrombosis (ST). Secondary endpoints: mortality and major adverse cardiovascular events (MACE). Cox regression analysis used.
Main Results:
- No association found between systemic inflammation and TLR or acute ST.
- Inflammatory biomarkers were significantly associated with all-cause mortality, cardiovascular mortality, and MACE.
- Adjusted hazard ratios for C-reactive protein showed no significant relation to TLR or ST.
Conclusions:
- Systemic inflammation is important for predicting mortality and MACE after PCI.
- Elevated baseline inflammatory parameters do not correlate with TLR or acute ST.
- PCI should not be delayed based on inflammatory markers in the era of second-generation drug-eluting stents.
Background:
Biomarkers of inflammation are reliable predictors of adverse cardiovascular events in coronary artery disease. However, the association between systemic inflammation and percutaneous coronary intervention (PCI)-related adverse events remains widely unclear.
Objectives:
The objective of this study was to investigate the association of routinely assessed inflammatory biomarkers C-reactive protein, leukocytes, and neutrophil-to-lymphocyte ratio (NLR) with patient outcomes in an unselected patient cohort undergoing PCI.
Methods:
A total of 7,412 patients (median age 64 years, 73.2% male) were enrolled in this single-center observational trial with a median follow-up time of 4.6 years. Target lesion revascularization (TLR) and acute stent thrombosis (ST) were defined as primary endpoints. Further endpoints included mortality, cardiovascular mortality, and 3-point major adverse cardiovascular events (MACE) (composite of cardiovascular mortality, myocardial infarction, and stroke). Cox proportional hazard regression was used for statistical analysis with a level of significance set at P < 0.01.
Results:
In the total study cohort, patients experiencing subsequent TLR (n = 488, 6.6%) had more comorbidities and underwent more complex primary interventions. Interestingly, no relation was found between systemic inflammation and subsequent TLR (eg, adjusted HR for C-reactive protein: 0.93 [95% CI: 0.85-1.03], P = 0.150), 30-day TLR (0.89 [95% CI: 0.75-1.05], P = 0.177), or acute ST (1.06 [95% CI: 0.79-1.42], P = 0.708) in multivariable analysis, neither in elective nor in acute interventions. All investigated inflammatory biomarkers were, however, significantly associated with all-cause mortality, cardiovascular mortality, and 3-point MACE, even after comprehensive adjustment for clinical and interventional parameters.
Conclusions:
While our results emphasize the importance of systemic inflammatory activation for mortality and MACE, elevated baseline inflammatory parameters show no correlation with TLR or acute ST and, therefore, should not delay PCI in the era of second-generation drug-eluting stents.
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