Post-PCI Risk Assessment by Inflammation Activity According to Disease Acuity and Time from Procedure.

Background:  High-sensitivity C-reactive protein (hs-CRP) has been proposed as an indicator of inflammation and cardiovascular risk. However, little is known of the comparative temporal profile of hs-CRP and its relation to outcomes according to the disease acuity.

Methods:  We enrolled 4,263 East Asian patients who underwent percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) and stable disease. hs-CRP was measured at baseline and 1 month post-PCI. Major adverse cardiovascular events (MACE: the composite occurrence of death, myocardial infarction, or stroke) and major bleeding were followed up to 4 years.

Result:  The AMI group ( = 2,376; 55.7%) had higher hs-CRP than the non-AMI group ( = 1,887; 44.3%) (median: 1.5 vs. 1.0 mg/L;  < 0.001), which remained higher at 1 month post-PCI (median: 1.0 vs. 0.9 mg/L;  = 0.001). During 1 month, a high inflammatory-risk phenotype (upper tertile: hs-CRP ≥ 2.4 mg/L) was associated with a greater MACE in the AMI group (adjusted hazard ratio [HR]: 7.66; 95% confidence interval [CI]: 2.29-25.59;  < 0.001), but not in the non-AMI group (HR: 0.74; 95% CI: 0.12-4.40;  = 0.736). Between 1 month and 4 years, a high inflammatory-risk phenotype (upper tertile: hs-CRP ≥ 1.6 mg/L) was associated with greater MACE compared to the other phenotype in both the AMI (HR: 2.40; 95% CI: 1.73-3.45;  < 0.001) and non-AMI groups (HR: 2.67; 95% CI: 1.80-3.94;  < 0.001).

Conclusion:  AMI patients have greater inflammation during the early and late phases than non-AMI patients. Risk phenotype of hs-CRP correlates with 1-month outcomes only in AMI patients. However, the prognostic implications of this risk phenotype appears similar during the late phase, irrespective of the disease acuity.