Is Residual Inflammatory Risk a Crucial Biomarker for PCI?

Persistent residual inflammatory risk following percutaneous coronary intervention (PCI) was associated with an increase in adverse cardiac outcomes, underlining the importance of the biomarker, a new study suggests.

The paper, published in the Journal of the American College of Cardiology, sought to characterize the prevalence of high residual inflammatory risk following PCI in a cohort with relatively low baseline low density lipoprotein cholesterol (LDL-C). The researchers looked at 3,013 patients with baseline LDL-C levels of 70 mg/dL or less who were undergoing PCI. Participants also had two serial high-sensitivity C-reactive protein (hsCRP) measurements, which served as the biomarker for residual inflammatory risk. The authors stratified the patient population into persistent residual inflammatory risk, attenuated risk, increased risk, and persistent high risk. High residual inflammatory risk was defined as hsCRP >2 mg/dL. The primary study endpoint was major adverse cardiac and cerebrovascular events (MACCE) within one year of the second hsCRP measurement.

High Residual Risk Bodes Poorly

According to the study results, 1,225 were classified as persistent low risk (41.7%), 414 (13.7%) attenuated risk, 346 (11.5%) increased risk, and 1,028 (34.1%) persistent high risk. The authors reported a step-wise increase in MACCE rates when transitioning from one stratification to the next. (P<0.001). The presence of persistent high residual inflammatory risk was strongly associated with MACCE, even after adjustment (adjusted HR=2.10; 95% CI, 1.45 to 3.02; P<0.001).

“Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high residual inflammatory risk is frequent and is associated with increased risk of MACCE,” the researchers wrote in their conclusion. “Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.”

Roxanna Mehran, MD, of the Ichan School of Medicine at Mount Sinai Hospital and a senior study author, said that interventionists need to take note of the utility of residual risk as a biomarker in these patients.

“It is really very, very important to understand that inflammation does play a role,” she said in an article at TCTMD about the study.  She also urged “outside of the box” thinking when it came to determining the source of inflammation in this patient cohort.