Author + information
- Received January 9, 2019
- Accepted January 31, 2019
- Published online May 13, 2019.
- Paul Guedeney, MDa,b,
- Bimmer E. Claessen, MD, PhDa,
- Deborah N. Kalkman, MD, PhDa,c,
- Melissa Aquino, MSa,
- Sabato Sorrentino, MD, PhDa,
- Gennaro Giustino, MDa,
- Serdar Farhan, MDa,
- Birgit Vogel, MDa,
- Samantha Sartori, PhDa,
- Gilles Montalescot, MD, PhDb,
- Joseph Sweeny, MDd,
- Jason C. Kovacic, MD, PhDd,
- Prakash Krishnan, MDd,
- Nitin Barman, MDd,
- George Dangas, MD, PhDa,
- Annapoorna Kini, MDd,
- Usman Baber, MD, MSa,
- Samin Sharma, MDd and
- Roxana Mehran, MDa,∗ (, )@Drroxmehran
- aIcahn School of Medicine at Mount Sinai Hospital, New York, New York
- bSorbonne Université, ACTION Study Group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
- cAmsterdam UMC, University of Amsterdam, Heart Center, and the Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- dMount Sinai Hospital, New York, New York
- ↵∗Address for correspondence:
Dr. Roxana Mehran, Center for Interventional Cardiovascular Research and Clinical Trials, Icahn School of Medicine at Mount Sinai, The Zena and Michael A. Wiener Cardiovascular Institute, One Gustave L. Levy Place, Box 1030, New York, New York 10029-6574.
Background Data on the impact of residual inflammatory risk (RIR) in patients undergoing percutaneous coronary intervention (PCI) with baseline low-density lipoprotein cholesterol (LDL-C) ≤70 mg/dl are scarce.
Objectives The purpose of this study was to characterize the prevalence and impact of persistent high RIR after PCI in patients with baseline LDL-C ≤70 mg/dl.
Methods All patients undergoing PCI between January 2009 and December 2016 in a single tertiary center, with baseline LDL-C ≤70 mg/dl and serial high-sensitivity C-reactive protein (hsCRP) assessments (at least 2 measurements ≥4 weeks apart) were retrospectively analyzed. High RIR was defined as hsCRP >2 mg/l. Patients were categorized as persistent low RIR (first low then low hsCRP), attenuated RIR (first high then low hsCRP), increased RIR (first low then high hsCRP), or persistent high RIR (first high then high hsCRP). Primary endpoint of interest was major adverse cardiac and cerebrovascular accident (MACCE) (death, myocardial infarction, or stroke), within 1 year of the second hsCRP measurement.
Results A total of 3,013 patients were included, with persistent low, attenuated, increased, and persistent high RIR in 1,225 (41.7%), 414 (13.7%), 346 (11.5%), and 1,028 (34.1%) patients, respectively. Overall, there was a stepwise increase in the incidence rates of MACCE, transitioning from the persistent low to the attenuated, increased, and persistent high RIR (respectively, 64.4 vs. 96.6 vs. 138.0 vs. 152.4 per 1,000 patient-years; p < 0.001). After adjustment, the presence of persistent high RIR remained strongly associated with MACCE (adjusted hazard ratio: 2.10; 95% confidence interval: 1.45 to 3.02; p < 0.001).
Conclusions Among patients undergoing PCI with baseline LDL-C ≤70 mg/dl, persistent high RIR is frequent and is associated with increased risk of MACCE. Targeting residual inflammation in patients with optimal LDL-C control may further improve outcomes after PCI.
Dr Montalescot has received research grants to the institution or consulting/lecture fees from ADIR, Amgen, AstraZeneca, Bayer, Berlin Chimie AG, Boehringer Ingelheim, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Celladon, CME Resources, Daiichi-Sankyo, Eli Lilly, Europa, Elsevier, Fédération Française de Cardiologie, Fondazione Anna Maria Sechi per il Cuore, Gilead, ICAN, Janssen, Lead-Up, Menarini, Medtronic, Merck Sharp and Dohme, Pfizer, Sanofi, The Medicines Company, TIMI Study Group, and WebMD. Dr. Barman has served as a consultant for CSI and Terumo Medical. Dr. Dangas has received consulting fees from Boston Scientific; has served as a consultant for Sanofi, AstraZeneca, and Abbott Vascular; and has served as an Advisory Board member for Abbott Vascular and Boston Scientific. Dr. Baber has received speaking honoraria from AstraZeneca and Boston Scientific. Dr. Sharma has performed industry-sponsored lectures for Abbott Laboratories, AngioScore, Inc., Boston Scientific Corporation, Cardiovascular Systems, Inc., Daiichi-Sankyo Co., Ltd./Eli Lilly and Company Partnership, Medtronic, Inc., and The Medicines Company; has served on the Scientific Advisory Board for Cardiovascular Systems, Inc.; and has served on the Speakers Bureau for Abbott Vascular, Boston Scientific, and Cardiovascular Systems, Inc. Dr. Mehran has received institutional research grant support from Eli Lilly/Daiichi-Sankyo, Bristol-Myers Squibb, AstraZeneca, The Medicines Company, OrbusNeich, Bayer, CSL Behring, Abbott Laboratories, Watermark Research Partners, Novartis Pharmaceuticals, Medtronic, AUM Cardiovascular, and Beth Israel Deaconess Medical Center; is a member of the executive committees for Janssen Pharmaceuticals, Bristol-Myers Squibb, and Osprey Medical; is a member of the data safety monitoring board of Watermark Research Partners; has received institutional (payment to institution) advisory board funding from Bristol-Myers Squibb and Novartis; has served as a consultant for Medscape, The Medicines Company, Boston Scientific, Merck & Company Cardiovascular Systems, Sanofi USA, Shanghai BraccoSine Pharmaceutical, and AstraZeneca; and holds equity in Claret Medical and Elixir Medical Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Brendan Everett, MD, MPH, served as Guest Associate Editor for this paper.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 9, 2019.
- Accepted January 31, 2019.
- 2019 American College of Cardiology Foundation
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