Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai Hospital, New York, One Gustave L. Levy Place, Box 1030, New York, NY, USA.
Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ, Amsterdam, The Netherlands.
Eur Heart J. 2018 Dec 7;39(46):4101-4108. doi: 10.1093/eurheartj/ehy633.
It remains unknown what percentage of patients treated with percutaneous coronary artery intervention (PCI) have high residual inflammatory risk (RIR). Moreover, the impact of RIR on clinical outcomes has not been established. The objective of this study is to determine the prevalence of patients with persistent high levels of inflammation after PCI and to evaluate clinical outcomes according to inflammatory response.
This is a retrospective cohort study assessing patients undergoing PCI between 2009 and 2016 with serial inflammatory status assessment from a large, prospective, and single-centre PCI registry. Assessment of inflammation status with at least two high sensitive C-reactive protein (hsCRP) measurements at baseline and follow-up with >4 weeks apart. High RIR was defined as an hsCRP≥ 2 mg/L. Patients were divided into four groups: persistent high RIR, increased RIR (first low-, then high hsCRP), attenuated RIR (first high-, then low hsCRP), or persistent low RIR. The primary endpoint was all-cause mortality at 1 year follow-up. Occurrence of myocardial infarction (MI) was assessed as secondary outcome. Seven thousand and twenty-six patients were identified with serial hsCRP measurements (30.8% of all PCI patients). Of these patients 2654 (38%) had persistent high RIR, 719 patients (10%) had increased RIR, 1088 patients (15%) had attenuated RIR, and persistent low RIR was seen in 2565 patients (37%). All-cause mortality at 1 year was 2.6% in patients with persistent high RIR, compared with 1.0% in increased RIR, 0.3% in attenuated RIR, and 0.7% in persistent low RIR patients, P < 0.01. MI at 1 year was observed in 7.5% of persistent high RIR, compared with 6.4% in increased RIR, 4.6% in attenuated RIR, and 4.3% in persistent low RIR, P < 0.01. In an adjusted model, including accounting for diabetes mellitus, acute coronary syndrome, and baseline low-density lipoprotein, results were sustained.
Persistent high RIR is observed frequently in patients undergoing PCI. In these patients, significantly higher all-cause mortality and MI rates are observed at 1 year follow-up. Residual inflammatory risk in patients undergoing PCI should be identified and treatment options should be further explored.
目前尚不清楚经皮冠状动脉介入治疗（PCI）后有多少患者存在高残余炎症风险（RIR）。此外，RIR 对临床结局的影响尚未确定。本研究的目的是确定 PCI 后持续存在高炎症水平的患者比例，并根据炎症反应评估临床结局。
这是一项回顾性队列研究，评估了 2009 年至 2016 年间在一家大型、前瞻性和单中心 PCI 注册中心接受 PCI 治疗的患者，该研究通过至少两次高敏 C 反应蛋白（hsCRP）测量来评估炎症状态，两次测量之间至少相隔 4 周。高 RIR 定义为 hsCRP≥2mg/L。患者分为四组：持续高 RIR、RIR 增加（先低后高 hsCRP）、RIR 衰减（先高后低 hsCRP）或持续低 RIR。主要终点是 1 年随访时的全因死亡率。心肌梗死（MI）的发生被评估为次要结局。确定了 7026 名接受 hsCRP 连续测量的患者（所有 PCI 患者的 30.8%）。其中 2654 名患者（38%）持续存在高 RIR，719 名患者（10%）RIR 增加，1088 名患者（15%）RIR 衰减，2565 名患者（37%）持续存在低 RIR。持续高 RIR 患者 1 年全因死亡率为 2.6%，高于 RIR 增加患者的 1.0%、RIR 衰减患者的 0.3%和持续低 RIR 患者的 0.7%，P<0.01。持续高 RIR 患者 1 年 MI 发生率为 7.5%，高于 RIR 增加患者的 6.4%、RIR 衰减患者的 4.6%和持续低 RIR 患者的 4.3%，P<0.01。在调整了糖尿病、急性冠脉综合征和基线低密度脂蛋白后，结果仍然成立。
PCI 后患者常出现持续高 RIR。这些患者在 1 年随访时观察到全因死亡率和 MI 发生率显著增加。应确定 PCI 后患者的残余炎症风险，并进一步探索治疗选择。
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