Residual Inflammatory Risk and its Association With Events in East Asian Patients After Coronary Intervention

Jong-Hwa Ahn; Udaya S Tantry; Min Gyu Kang; Hyun Woong Park; Jin-Sin Koh; Jae Seok Bae; Sang Young Cho; Kye-Hwan Kim; Jeong Yoon Jang; Jeong Rang Park; Yongwhi Park; Seok-Jae Hwang; Choong Hwan Kwak; Jin-Yong Hwang; Paul A Gurbel; Young-Hoon Jeong

doi:10.1016/j.jacasi.2021.11.014

Residual Inflammatory Risk and its Association With Events in East Asian Patients After Coronary Intervention

JACC Asia. 2022 Apr 12;2(3):323-337. doi: 10.1016/j.jacasi.2021.11.014. eCollection 2022 Jun.

Authors

Jong-Hwa Ahn¹, Udaya S Tantry², Min Gyu Kang³, Hyun Woong Park³, Jin-Sin Koh³, Jae Seok Bae¹, Sang Young Cho¹, Kye-Hwan Kim³, Jeong Yoon Jang¹, Jeong Rang Park³, Yongwhi Park¹, Seok-Jae Hwang³, Choong Hwan Kwak¹, Jin-Yong Hwang³, Paul A Gurbel², Young-Hoon Jeong^{1

4}

Affiliations

¹ Department of Internal Medicine, Gyeongsang National University School of Medicine and Cardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
² Sinai Center for Thrombosis Research and Drug Development, Sinai Hospital of Baltimore, Baltimore, Maryland, USA.
³ Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, South Korea.
⁴ Institute of the Health Sciences, Gyeongsang National University, Jinju, South Korea.

Abstract

Background: East Asian population has a low level of inflammation compared with Western population. The prognostic implication of residual inflammatory risk (RIR) remains uncertain in East Asians.

Objectives: This study sought to provide an analysis to estimate early-determined RIR and its association with clinical outcomes in East Asian patients with coronary artery disease (CAD).

Methods: In an East Asian registry including patients with CAD undergoing percutaneous coronary intervention (PCI) (n = 4,562), RIR status was determined by measuring high-sensitivity C-reactive protein (hsCRP) serially at admission and at 1-month follow-up. Patients were stratified into 4 groups according to hsCRP criteria (≥2 mg/L): 1) persistent low RIR (low_{on admission}-low_{1 month}: 51.0%); 2) fortified RIR (low_{on admission}-high _{1 month}: 10.3%); 3) attenuated RIR (high_{on admission}-low_{1 month}: 20.5%); and 4) persistent high RIR (high_{on admission}-high_{1 month}: 18.3%). The risks of all-cause death, ischemic events, and major bleeding were evaluated.

Results: In our cohort, median levels of hsCRP were significantly decreased over time (1.3 to 0.9 mg/L; P < 0.001). Compared with hsCRP on admission, hsCRP at 1 month showed the greater associations with all-cause death and ischemic event. During clinical follow-up, risks of clinical events were significantly different across the groups (log-rank test, P < 0.001). Compared with other RIR groups, persistent high RIR showed the higher risk for all-cause death (HR_adjusted, 1.92; 95% CI: 1.44 to 2.55; P < 0.001), ischemic events (HR_adjusted, 1.26; 95% CI: 1.02 to 1.56; P = 0.032), and major bleeding (HR_adjusted, 1.98; 95% CI: 1.30 to 2.99; P < 0.001), respectively.

Conclusions: Approximately one-fifth of East Asian patients with CAD have persistent high RIR, which shows the close association with occurrence of ischemic and bleeding events. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).

Keywords: AMI, acute myocardial infarction; ASCVD, atherosclerotic cardiovascular disease; C-reactive protein; CAD, coronary artery disease; CKD, chronic kidney disease; East Asian; LDL-C, low-density lipoprotein cholesterol; MACE, major adverse cardiovascular events; PCI, percutaneous coronary intervention; RIR, residual inflammatory risk; coronary artery disease; hsCRP, high sensitivity C-reactive protein; residual inflammation.

Associated data

ClinicalTrials.gov/NCT04650529