Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
J Cardiol. 2022 Apr;79(4):509-514. doi: 10.1016/j.jjcc.2021.10.023. Epub 2021 Nov 16.
Inflammatory status is associated with cardiovascular events in patients with coronary artery disease (CAD) and renal function impairment. Chronic kidney disease (CKD) increases the incidence of cardiovascular events. However, whether the presence of residual inflammatory risk (RIR) and CKD together has a synergistic effect on the long-term clinical outcomes of patients with stable CAD undergoing percutaneous coronary intervention (PCI) remains unclear.
We assessed 2,948 consecutive patients with stable CAD who underwent the first PCI from 2000 to 2016. Of these, we analyzed the data of patients (2,087) with measurements of high-sensitivity C-reactive protein (hs-CRP) available at follow-up (6-9 months later). High RIR was defined as hs-CRP of >0.6 mg/L according to the median value at follow-up. Patients were classified into four groups: Group 1 (low RIR, non-CKD), Group 2 (high RIR, non-CKD), Group 3 (low RIR, CKD), and Group 4 (high RIR, CKD). We evaluated all-cause mortality and major adverse cardiac events (MACE). The median follow-up period was 5.2 (interquartile range, 1.9-9.9) years.
In total, 189 (16.1%) and 128 (11.2%) cases of all-cause mortality and MACE, respectively, were identified during follow-up. The rates of all-cause mortality and MACE were significantly higher in Group 4 than those in the other groups (p<0.001). There was a stepwise increase in the incidence of all-cause mortality and MACE. Upon adjustment for important covariates, the presence of high RIR and/or CKD showed an independent association with a high incidence of MACE and all-cause mortality.
The presence of high RIR and CKD conferred a synergistic adverse effect on the long-term clinical outcomes of patients undergoing PCI.
炎症状态与冠心病（CAD）患者和肾功能损害患者的心血管事件有关。慢性肾脏病（CKD）增加了心血管事件的发生率。然而，残余炎症风险（RIR）和 CKD 同时存在是否对接受经皮冠状动脉介入治疗（PCI）的稳定型 CAD 患者的长期临床结局有协同作用尚不清楚。
我们评估了 2000 年至 2016 年期间首次接受 PCI 的 2948 例连续稳定型 CAD 患者。其中，我们分析了在随访（6-9 个月后）时可获得高敏 C 反应蛋白（hs-CRP）测量值的患者（2087 例）的数据。高 RIR 定义为根据随访时的中位数，hs-CRP >0.6mg/L。患者分为四组：组 1（低 RIR，非 CKD）、组 2（高 RIR，非 CKD）、组 3（低 RIR，CKD）和组 4（高 RIR，CKD）。我们评估了全因死亡率和主要不良心脏事件（MACE）。中位随访时间为 5.2 年（四分位距，1.9-9.9）。
在随访期间，共发生 189 例（16.1%）全因死亡和 128 例（11.2%）MACE。与其他组相比，组 4 的全因死亡率和 MACE 发生率显著更高（p<0.001）。全因死亡率和 MACE 的发生率呈阶梯式上升。在调整重要协变量后，高 RIR 和/或 CKD 的存在与 MACE 和全因死亡率的高发生率有独立相关性。
高 RIR 和 CKD 的存在对接受 PCI 的患者的长期临床结局有协同的不良影响。
