Takahashi Norihito, Dohi Tomotaka, Endo Hirohisa, Funamizu Takehiro, Wada Hideki, Doi Shinichiro, Kato Yoshiteru, Ogita Manabu, Okai Iwao, Iwata Hiroshi, Okazaki Shinya, Isoda Kikuo, Miyauchi Katsumi, Shimada Kazunori
Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
Department of Cardiology, Juntendo University Shizuoka Hospital, 1129 nagaoka, Izunokuni-shi 410-2295, Shizuoka, Japan.
J Clin Med. 2020 Apr 6;9(4):1033. doi: 10.3390/jcm9041033.
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 ( < 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 ( < 0.001). After adjustment, the presence of persistent high RIR (hazard ratio (HR) 2.22; 95% confidence interval (CI) 1.37-3.67, = 0.001), increased RIR (HR 2.25, 95%CI 1.09-4.37, = 0.029), and attenuated RIR (HR 1.94, 95%CI 1.14-3.32, = 0.015) were predictive for MACE. In addition, presence of persistent high RIR (HR 2.07, 95%CI 1.41-3.08, < 0.001) and increased RIR (HR 1.94, 95%CI 1.07-3.36, = 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.
本研究旨在通过评估亚洲冠心病（CAD）患者的系列高敏C反应蛋白（hs-CRP），探讨残余炎症风险（RIR）的长期临床影响。我们评估了2032例接受经皮冠状动脉介入治疗（PCI）的稳定CAD患者，这些患者在2000年至2016年期间进行了系列hs-CRP测量（2次测量，间隔6 - 9个月）。根据中位数，高RIR定义为hs-CRP>0.9mg/L。患者被分为四组：持续高RIR、RIR增加、RIR减弱或持续低RIR。评估主要不良心脏事件（MACE）和全因死亡情况。持续高、RIR增加和RIR减弱的患者的MACE发生率显著高于持续低RIR的患者（<0.001）。此外，持续高RIR和RIR增加的患者的全因死亡率显著高于RIR减弱和持续低RIR的患者（<0.001）。调整后，持续高RIR（风险比（HR）2.22；95%置信区间（CI）1.37 - 3.67，=0.001）、RIR增加（HR 2.25，95%CI 1.09 - 4.37，=0.029）和RIR减弱（HR 1.94，95%CI 1.14 - 3.32，=0.015）可预测MACE。此外，持续高RIR（HR 2.07，95%CI 1.41 - 3.08，<0.001）和RIR增加（HR 1.94，95%CI 1.07 - 3.36，=0.029）可预测全因死亡。在日本CAD患者中，高RIR与MACE和全因死亡显著相关。炎症变化的评估可能携带重要的预后信息，并可能指导治疗方法。
