Abstract
BACKGROUND: The applicability of currently established high-risk inflammatory criteria to East Asian patients is unknown, particularly concerning the hypersensitive C-reactive protein (hs-CRP) cutoff value. In addition, the role of cholesterol and inflammation in determining the prognosis of these patients might shift after the patient accepts lipid-lowering treatments. This study aimed to explore the high-risk hs-CRP cutoff value and compare the prognostic value between inflammation and cholesterol risk in the East Asian population after treatment with percutaneous coronary intervention (PCI). METHODS: Post-PCI patients with serial hs-CRP and low-density lipoprotein cholesterol (LDL-C) level measurements were retrospectively enrolled. Major adverse cardiovascular and cerebrovascular events (MACCEs) were defined as a composite of cardiovascular death, non-fatal acute myocardial infarction (AMI), non-fatal stroke, and unplanned coronary revascularization. The association between residual risks and MACCEs was evaluated. RESULTS: During a median follow-up of 30.4 months, 403 MACCEs occurred among 2373 patients. The high-risk LDL-C and hs-CRP cutoff values in the present study were set at 1.56 mg/L and 1.80 mmol/L, respectively, based on the results of tertile stratification and restricted cubic spline analysis. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of residual cholesterol risk (hs-CRP <1.56 mg/L; LDL-C ≥1.80 mmol/L), residual inflammatory risk (hs-CRP ≥1.56 mg/L; LDL-C <1.80 mmol/L), and residual cholesterol and inflammatory risk (hs-CRP ≥1.56 mg/L; LDL-C ≥1.80 mmol/L) for MACCEs were 1.26 (0.95-1.66), 2.15 (1.57-2.93), and 2.07 (1.55-2.76), respectively. Inflammatory-induced MACCEs were more likely to be associated with the increased risk of non-fatal AMI (HR: 4.48; 95% CI: 2.07-9.73; p < 0.001), while cholesterol-induced MACCEs were more likely to be associated with the increased risk of non-target vessel revascularization (TVR: HR: 1.60; 95% CI: 1.08-2.37; p = 0.019). Persistent high inflammatory risk (baseline and follow-up hs-CRP ≥1.56 mg/L) can be a major determinant of MACCEs (adjusted HR: 2.03; 95% CI: 1.64-2.52; p < 0.001), while persistent high cholesterol risk (baseline and follow-up LDL-C ≥1.80 mmol/L) was not. Serial hs-CRP measurements could produce more predictive values for MACCEs than a single measurement. CONCLUSIONS: Despite statin treatment, residual cholesterol and inflammatory risks persist in post-PCI patients. The high-risk hs-CRP standard may be lower in East Asian patients than their Western counterparts, with a cutoff value of 1.56 mg/L. Inflammation and cholesterol could be major determinants for recurrent cardiovascular events, while hs-CRP seems to be a stronger predictor than LDL-C in post-PCI patients receiving statin therapy. CLINICAL TRIAL REGISTRATION: ChiCTR2100047090, https://www.chictr.org.cn/showproj.html?proj=127821.