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Long-Term Outcomes After Percutaneous Coronary Intervention According to the High-Sensitivity C-Reactive
Yueyue Cao1,2,3, Yicheng Tong1,2,3, Zhao Wang1,2,3
1Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, 100191 Beijing, China.
Insights
Elevated high-sensitivity C-reactive protein to albumin ratio (hsCAR) predicts major adverse cardiac events (MACEs) in patients with chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) after percutaneous coronary intervention (PCI). hsCAR aids in risk stratification for this population.
Area of Science:
- Cardiology
- Pulmonology
- Biomarker Research
Background:
- Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) often coexist, linked by systemic inflammation.
- The high-sensitivity C-reactive protein to albumin ratio (hsCAR) is a novel biomarker reflecting inflammation and nutritional status.
Purpose of the Study:
- To evaluate the prognostic significance of hsCAR in patients with concomitant COPD and CAD undergoing percutaneous coronary intervention (PCI).
Main Methods:
- A cohort study included 262 patients with COPD-CAD undergoing PCI (2014-2019).
- Patients were stratified into tertiles based on baseline hsCAR levels.
- The primary endpoint was major adverse cardiac events (MACEs), with follow-up up to 4 years. Kaplan-Meier curves and Cox regression analyzed MACE incidence.
Main Results:
- Higher hsCAR levels correlated with increased MACE incidence.
- Patients in the highest hsCAR tertile (Group C) had significantly higher MACE rates compared to the lowest tertile (Group A) (19.5% vs. 5.7%, HR=3.27, p=0.035).
- ROC analysis indicated hsCAR's discriminatory ability (AUC=0.651, p=0.004), with RCS analysis showing a linear risk increase above hsCAR=0.0446.
Conclusions:
- Elevated baseline hsCAR is an independent predictor of long-term MACEs in COPD-CAD patients post-PCI.
- hsCAR is an accessible biomarker for risk stratification and guiding secondary prevention strategies in this high-risk group.
Background:
Chronic obstructive pulmonary disease (COPD) and coronary artery disease (CAD) frequently occur together, with systemic inflammation linking these two conditions. Recently, the high-sensitivity C-reactive protein to albumin ratio (hsCAR) has been identified as a composite biomarker of inflammation and nutrition. Thus, this study aimed to examine the prognostic value of hsCAR in patients with COPD-CAD undergoing percutaneous coronary intervention (PCI).
Methods:
In this cohort study, consecutive patients with COPD-CAD who underwent PCI between 2014 and 2019 were enrolled and categorized into tertiles by hsCAR values. The primary endpoint was major adverse cardiac events (MACEs), including cardiac death, target vessel revascularization (TVR), and nonfatal myocardial infarction (MI). Patients underwent a follow-up for up to 4 years, and the incidence of MACEs was compared between the hsCAR groups using Kaplan-Meier curves and Cox regression analyses.
Results:
A total of 262 patients were enrolled. Over a median follow-up of approximately 4 years, higher hsCAR levels were associated with an increased incidence of MACEs. The cumulative incidence of MACEs was highest in Group C (hsCAR ≥0.079). The incidence of MACEs was significantly higher in Group C than in Group A (19.5% vs. 5.7%; hazard ratio (HR) = 3.27, 95% confidence interval (CI): 1.08-9.86; p = 0.035). Receiver operating characteristic (ROC) curve analysis confirmed the associated discriminatory ability (area under the curve (AUC) = 0.651; p = 0.004). Restricted cubic spline (RCS) analysis showed a linear increase in the risk of MACEs as the absolute value of hsCAR exceeded 0.0446. Subgroup analyses revealed consistent associations across strata, with no significant interactions.
Conclusion:
Elevated baseline hsCAR is an independent predictor of long-term MACEs in patients with COPD-CAD undergoing PCI. As an inexpensive and readily available biomarker, hsCAR could be used for post-PCI risk stratification to guide targeted secondary prevention in this high-risk population.
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