Residual Inflammation Indicated by High-Sensitivity C-Reactive Protein Predicts Worse Long-Term Clinical Outcomes in Japanese Patients after Percutaneous Coronary Intervention

• Main Authors: Norihito Takahashi, Tomotaka Dohi, Hirohisa Endo, Takehiro Funamizu, Hideki Wada, Shinichiro Doi, Yoshiteru Kato, Manabu Ogita, Iwao Okai, Hiroshi Iwata, Shinya Okazaki, Kikuo Isoda, Katsumi Miyauchi, Kazunori Shimada
• Format: Article
• Language: English
• Published: MDPI AG 2020-04-01
• Series: Journal of Clinical Medicine
• Subjects: hs-CRP; residual risk; biomarker; inflammation; coronary artery disease; percutaneous coronary intervention
• Online Access: https://www.mdpi.com/2077-0383/9/4/1033

The aim of this study was to investigate the long-term clinical impact of residual inflammatory risk (RIR) by evaluating serial high-sensitivity C-reactive protein (hs-CRP) in Asian patients with coronary artery disease (CAD). We evaluated 2032 patients with stable CAD undergoing percutaneous coronary intervention (PCI) with serial hs-CRP measurements (2 measurements, 6–9 months apart) from the period 2000 to 2016. A high-RIR was defined as hs-CRP > 0.9 mg/L according to the median value. Patients were assigned to four groups: persistent-high-RIR, increased-RIR, attenuated-RIR, or persistent-low-RIR. Major adverse cardiac events (MACE) and all-cause death were evaluated. MACE rates in patients with persistent high, increased and attenuated RIR were significantly higher than in patients with persistent low RIR (<i>p</i> < 0.001). Moreover, the rate of all-cause death was significantly higher among patients with persistent high and increased RIR than among patients with attenuated and persistent low RIR (<i>p</i> < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37–3.67, <i>p</i> = 0.001), increased RIR (HR 2.25, 95%CI 1.09–4.37, <i>p</i> = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14–3.32, <i>p</i> = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41–3.08, <i>p</i> < 0.001) and increased RIR (HR 1.94, 95%CI 1.07–3.36, <i>p</i> = 0.029) were predictive for all-cause death. A high RIR was significantly associated with MACE and all-cause death among Japanese CAD patients. An evaluation of changes in inflammation may carry important prognostic information and may guide the therapeutic approach.