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Residual Cardiovascular Biomarkers After Medical Therapy and Their Prognostic Implications Following Percutaneous
Jun Hwan Cho1, Jong-Hwa Ahn2, Min Gyu Kang3
1Division of Cardiology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong and Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea.
Insights
Elevated fibrinogen levels after percutaneous coronary intervention (PCI) predict major adverse cardiovascular events in high-risk patients. Further research is needed to explore adjunctive therapies for improved outcomes in this population.
Area of Science:
- Cardiology
- Biomarker Research
- Interventional Cardiology
Background:
- Atherothrombotic events continue to be a significant clinical challenge in high-risk patients with coronary artery disease, even with existing medical therapies.
- Identifying reliable biomarkers is crucial for risk stratification and management of these patients.
Purpose of the Study:
- To investigate the association between various atherothrombotic biomarkers and clinical outcomes in patients undergoing percutaneous coronary intervention (PCI).
- To determine the predictive value of biomarkers measured post-PCI for major adverse cardiovascular events (MACE).
Main Methods:
- A cohort of 2,789 patients undergoing PCI had lipid profile, high-sensitivity C-reactive protein (hs-CRP), P2Y12 reaction units, and fibrinogen levels measured at admission and 1 month post-PCI.
- Major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke) were tracked from 1 month to 4 years post-PCI.
- Statistical analyses, including covariate-adjusted hazard ratios (HRs), were used to assess biomarker associations with MACE.
Main Results:
- While most biomarkers decreased post-PCI, fibrinogen levels showed a significant increase (329 ± 86 to 359 ± 92 mg/dL; P < 0.001).
- Elevated levels of hs-CRP and fibrinogen at 1 month post-PCI were significantly associated with increased risk of MACE.
- One-month fibrinogen levels emerged as the strongest independent predictor of MACE (HRs for highest quartile: 2.23; P < 0.001), showing the highest correlation with hs-CRP (r = 0.426).
Conclusions:
- In patients treated with PCI, elevated fibrinogen levels at 1 month are strongly associated with adverse cardiovascular outcomes.
- Fibrinogen may serve as a critical prognostic biomarker in this patient population.
- Further investigation into adjunctive therapies targeting fibrinogen is warranted to improve outcomes for high-risk patients post-PCI.
Background:
Despite medical therapy, atherothrombotic events remain common in high-risk patients with coronary artery disease.
Objectives:
The purpose of this study was to evaluate the association between atherothrombotic biomarkers and outcomes in patients with coronary artery disease who are undergoing percutaneous coronary intervention (PCI).
Methods:
Biomarkers including lipid profile (low-density lipoprotein cholesterol and triglycerides), inflammation (high-sensitivity C-reactive protein [hs-CRP]), platelet reactivity (P2Y12 reaction unit), and coagulation (fibrinogen) were measured on admission and at 1 month following medical therapy post-PCI (n = 2,789). The primary endpoint was major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, or stroke, occurring between 1 month and 4 years post-PCI.
Results:
Biomarker levels decreased significantly (all P values ≤ 0.001), except for fibrinogen levels (329 ± 86 vs 359 ± 92 mg/dL; P < 0.001). The median follow-up of the participants was 2.2 years (IQR: 1.3-4.0 years). Covariate-adjusted HRs for the lowest to highest quartiles were 1.00 (referent) (95% CI), 1.37 (0.78-2.41), 1.89 (1.11-3.21), and 1.71 (1.01-2.91) for 1-month hs-CRP; and 1.00 (referent), 1.49 (0.83-2.67), 1.83 (1.03-3.26), and 2.47 (1.40-4.36) for 1-month fibrinogen. Among these biomarkers, hs-CRP and fibrinogen levels at 1 month showed the highest correlation (r = 0.426). After adjusting for covariates and biomarkers, the 1-month fibrinogen level was the strongest incremental predictor of major adverse cardiovascular event (HRs: 1.00 [referent], 1.45 [0.80-2.62], 1.65 [0.91-2.98], and 2.23 [1.20-4.12], P < 0.001).
Conclusions:
Among medically treated patients following PCI, elevated fibrinogen levels were associated with adverse outcomes. Further studies are warranted to clarify these associations and to determine whether adjunctive therapies can improve outcomes in this high-risk group. (Gyeongsang National University Hospital [GNUH] Registry; NCT04650529).
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