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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Prognostic impact of combined inflammatory markers in patients undergoing percutaneous coronary intervention
Francesca Maria Di Muro1, Valeria Raona2, Samantha Sartori3
1Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Medicine, Surgery, and Dentistry, University of Salerno, Salerno, Italy.
Insights
Elevated neutrophil-to-lymphocyte ratio (NLR) combined with high-sensitivity C-reactive protein (hs-CRP) significantly increases cardiovascular risk after percutaneous coronary intervention (PCI). This dual-marker approach enhances risk stratification beyond single biomarkers.
Area of Science:
- Cardiology
- Inflammation Research
- Biomarker Analysis
Background:
- High-sensitivity C-reactive protein (hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) are known cardiovascular risk factors.
- Their combined prognostic value in patients undergoing percutaneous coronary intervention (PCI) requires further investigation.
Purpose of the Study:
- To evaluate the combined prognostic significance of hs-CRP and NLR for major adverse cardiovascular events (MACE) in patients undergoing PCI.
- To determine if a dual-marker inflammatory approach improves risk stratification post-PCI.
Main Methods:
- A cohort of 7,303 patients undergoing PCI between 2012 and 2022 was analyzed.
- Patients were stratified based on hs-CRP (≥2 mg/L vs <2 mg/L) and NLR (≥75th vs <75th percentile).
- Multivariable Cox proportional hazards models assessed the association with 1-year MACE.
Main Results:
- Concomitantly elevated NLR and hs-CRP were associated with the highest MACE incidence.
- Elevated NLR increased MACE risk across hs-CRP strata, with a significant association persisting only when hs-CRP was ≥2 mg/L.
- The association was primarily driven by all-cause mortality and myocardial infarction.
Conclusions:
- Elevated NLR, especially when combined with hs-CRP ≥2 mg/L, identifies a gradient of increasing cardiovascular risk in PCI patients.
- A dual-marker inflammatory assessment may offer superior risk stratification compared to single biomarkers post-PCI.
Background And Aim:
Inflammatory markers such as high-sensitivity C-reactive protein (hs-CRP) and the neutrophil-to-lymphocyte ratio (NLR) have been individually associated with cardiovascular risk in patients undergoing percutaneous coronary intervention (PCI). However, their combined prognostic value remains incompletely defined.
Methods:
Consecutive patients undergoing PCI between 2012 and 2022 were included and stratified according to baseline hs-CRP (≥2 mg/L vs <2 mg/L) and NLR (≥75th vs <75th percentile). The primary endpoint was 1-year major adverse cardiovascular events (MACE). Multivariable Cox proportional hazards models were used to assess associations after adjustment for confounders.
Results:
Among 7,303 included patients, those with concomitantly elevated NLR and hs-CRP exhibited the highest incidence of overall MACE, followed by patients with only one elevated inflammatory marker, while the lowest event rates were observed in those with both markers below threshold. No significant interaction between NLR and hs-CRP was observed (P = .451). Elevated NLR was associated with a higher risk of MACE in both hs-CRP strata (hs-CRP ≥2 mg/L: hazard ratio 1.83, 95% confidence interval 1.42-2.35, P < .001; hs-CRP <2 mg/L: hazard ratio 1.55, 95% confidence interval 1.10-2.17, P = .012). After multivariable adjustment, this association remained significant only in patients with hs-CRP ≥2 mg/L, driven primarily by all-cause mortality and myocardial infarction.
Conclusion:
In patients undergoing PCI, elevated NLR identifies a gradient of increasing risk, particularly when combined with hs-CRP ≥2 mg/L. A dual-marker inflammatory approach may improve post-PCI risk stratification beyond either biomarker alone.
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