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

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)