Physicians' Academy for Cardiovascular Education

Increased inflammatory status associated with worse outcomes post PCI

Residual inflammatory risk and the impact on clinical outcomes in patients after percutaneous coronary interventions

Literature - Kalkman DN, Aquino M, Claessen BE et al. - Eur Heart J 2018; published online ahead of print

Introduction and methods

Residual inflammatory risk (RIR), defined as hsCRP >2 mg/L and LDL-c >70mg/dL, describes the inflammatory status in patients with known CVD [1-4]. The prevalence of persistent high RIR in patients undergoing percutaneous coronary interventions (PCI) is not well established and current guidelines do not recommend its assessment. Moreover, the association between RIR and clinical outcomes in post-PCI patients is not known.

This study assessed the prevalence of persistent high RIR in patients undergoing PCI, and evaluated the association with adverse clinical outcomes at one year after PCI. For this purpose, a retrospective analysis of a PCI registry (MountSinai Hospital,NY,USA) was conducted between 1 January 2009 and 31 December 2016. Patients with ≥2 serial hsCRP measurements within four weeks or more were stratified into four RIR groups:

The primary endpoint was one year all-cause death and the secondary endpoints were myocardial infarction (MI), target vessel revascularization, target lesion revascularization (TLR), bleeding, stent thrombosis, cerebrovascular accident (CVA), major adverse cardiovascular events (MACE), and MACE+. MACE was defined as the composite of all-cause death, MI, and stroke and MACE+ as the composite endpoint of all-cause death, MI, stroke, and any revascularization.

Main results


A high percentage of patients undergoing PCI have persistent high RIR, which results in a higher one year rate of all-cause death and MI, compared with persistent low RIR. These data show that determining RIR in PCI patients identifies a high-risk population. Whether the use of anti-inflammatory medication in this population reduces recurrent cardiovascular events, deserves further investigation.


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Find this article online at Eur Heart J

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