A new study has found that persistent high residual inflammatory risk (RIR), defined as the presence of high inflammatory status at presentation and at follow-up, is associated with an increased major adverse cardiac and cerebrovascular accident (MACCE) risk in patients undergoing percutaneous coronary intervention (PCI) with a low-density lipoprotein (LDL) level of 70 mg/dL or less at baseline. The findings from this study were published the Journal of the American College of Cardiology.
The researchers performed a retrospective analysis of a prospective PCI registry comprised of patients from The Mount Sinai Hospital. Only patients who underwent PCI between 2009 and 2016 with a baseline LDL-C of ≤70 mg/dL and serial high-sensitivity C-reactive protein measurements (≥2 measurements 4 weeks apart or more) were included in the analysis. Based on baseline assessments, patients were categorized as either persistent low RIR (1225), attenuated RIR (414), increased RIR (346), or persistent high RIR (1028). The primary end point was MACCE, which was composed of death, myocardial infarction, or stroke within a 1-year period of the second high-sensitivity C-reactive protein assessment.
Patients with increased RIR or persistent high RIR were more likely to have comorbidities such as diabetes mellitus or chronic kidney disease. At 1 year, the overall MACCE incidence rate was 106.6 per 1000 person-years, whereas the incidence rate of all-cause death was 35.9 per 1000 person-years. A stepwise increase in MACCE rates was found from persistent low RIR (64.4 per 1000 patient-years) to attenuated RIR (96.6 per 1000 patient-years) to increased RIR (138.0 per 1000 patient-years) to persistent high RIR (152.4 per 1000 patient-years; all P <.001). According to the adjusted analysis, the strongest factor associated with MACCE was persistent high RIR (adjusted hazard ratio, 2.10; 95% CI, 1.45-3.02; P <.001).
Limitations of the study include its retrospective nature as well as the use of a single-center prospective registry.
“Further studies are needed to determine whether treatment aimed at ameliorating residual inflammation in patients with optimal LDL-C control improve clinical outcomes after PCI,” the researchers concluded.
Guedeney P, Claessen BE, Kalkman DN, et al. Residual inflammatory risk in patients with low LDL cholesterol levels undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2019;73:2401-2409.