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Residual inflammatory risk and clinical outcomes after contemporary percutaneous coronary intervention: a systematic
Francisco José Romeo1, Michele Golino2,3, Matteo Morello3,4
1Department of Cardiology, University of Miami Miller School of Medicine, Jackson Memorial Hospital, 1120 NW 14th St, Miami, FL, 33136, USA. fjr62@miami.edu.
Insights
High residual inflammatory risk (RIR), indicated by elevated hsCRP levels post-PCI, significantly increases the risk of major adverse cardiovascular events and mortality in high-risk patients. This finding highlights the need for targeted anti-inflammatory therapies.
Area of Science:
- Cardiology
- Inflammation Research
- Interventional Cardiology
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) and subclinical inflammation (hsCRP) are key drivers of atherosclerosis.
- High-risk patients often exhibit residual risks, including residual inflammatory risk (RIR), despite optimal medical therapy.
- Percutaneous coronary intervention (PCI) is a common procedure for managing coronary artery disease.
Purpose of the Study:
- To investigate the impact of residual inflammatory risk (RIR) on cardiovascular outcomes in patients undergoing contemporary PCI.
- To evaluate the association between persistent high RIR and major adverse cardiovascular events (MACE) after PCI.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, EMBASE, Cochrane, MEDLINE) up to December 2024.
- Included studies focused on patients with coronary artery disease undergoing PCI, assessing inflammatory burden via hsCRP measurements at baseline and follow-up (>4 weeks apart).
- High RIR was defined as hsCRP ≥ 2 mg/L at 1-month follow-up; meta-analysis used random-effects models to compute risk ratios (RR) and 95% confidence intervals (CI).
Main Results:
- Five studies involving 13,604 patients were analyzed, with 5,833 identified as having high RIR at 30 days post-PCI.
- Persistent high RIR was significantly associated with increased risk of MACE (RR=1.64, 95% CI 1.33-2.03).
- High RIR also correlated with higher all-cause mortality (RR=3.25, 95% CI 2.49-4.25), non-fatal myocardial infarction (RR=1.46, 95% CI 1.00-2.12), and non-fatal stroke (RR=1.64, 95% CI 1.14-2.37).
Conclusions:
- In patients undergoing contemporary PCI, a high residual inflammatory risk is a significant predictor of adverse cardiovascular outcomes.
- These findings underscore the importance of monitoring and managing RIR in high-risk cardiovascular populations.
- The results suggest that tailored anti-inflammatory and lipid-lowering therapies may be beneficial for patients with persistent high RIR post-PCI.
Abstract:
Elevated low-density lipoprotein cholesterol (LDL-C) and subclinical inflammation - measured with high-sensitivity C-reactive protein (hsCRP) - contribute to atherosclerosis progression. Despite medical therapy, high-risk patients may still have residual cholesterol risk, residual inflammatory risk (RIR), both, or neither. We aimed to study the impact of RIR in patients undergoing contemporary percutaneous coronary intervention (PCI). A comprehensive search of Pubmed, EMBASE, Cochrane and MEDLINE was performed up to December 2024. Only studies including patients with coronary artery disease undergoing PCI were considered. Inflammatory burden was evaluated with two hs-CRP measurements at baseline and follow-up (> 4 weeks apart). High RIR was defined as hsCRP ≥ 2 mg/L at 1-month follow-up. The risk ratio (RR) with a 95% confidence interval (CI) was computed using a random-effect model. We identified five studies enrolling 13,604 patients, including 5,833 with high RIR at 30 days post-PCI. At 12-month follow-up, persistent high RIR was associated with an increased risk of major adverse cardiovascular events (MACE) (random-effects RR = 1.64, 95% CI 1.33-2.03; I² = 80.2%). High RIR was also associated with increased all-cause mortality (random-effects RR = 3.25, 95% CI 2.49-4.25; I² = 67%), non-fatal myocardial infarction (random-effects RR = 1.46, 95% CI 1.00-2.12; I² = 73%), and non-fatal stroke (random-effects RR = 1.64, 95% CI 1.14-2.37; I² = 0%). Sensitivity analyses, including Baujat plots and leave-one-out analyses, identified a single study as a major contributor to heterogeneity; exclusion of this study substantially reduced heterogeneity without materially altering the direction or magnitude of the associations. In patients undergoing contemporary PCI, a high RIR was associated with a significantly higher risk of adverse cardiovascular outcomes. This data could help tailor lipid-lowering and anti-inflammatory therapies in this high-risk population.
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