Abstract
Background Inflammation poses dual effects after myocardial infarction, but robust evidence shows that high-sensitivity C-reactive protein (hsCRP), as an inflammatory marker, is constantly associated with worse outcomes. This study is aimed at investigating the probable nonlinear association between postprocedural hsCRP and mortality in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention (PCI). Methods A total of 3940 consecutive ACS patients treated by PCI with postprocedural hsCRP measurements were retrospectively recruited. Patients were stratified into 5 groups according to quintiles of hsCRP. Cox regression with adjustments for multiple covariates was used for outcome analysis. Restricted cubic spline (RCS) analysis was used to allow possible nonlinear associations. The primary outcome was all-cause death. Results During a median follow-up of 727 days, mortality occurred in 207 (5.3%) patients. Adjusted hazard ratio (HR) was higher in the lowest (<2.26 mg/L, HR: 1.90, 95% confidence interval (CI): 1.08-3.33; P = 0.025), second highest (10.16-12.56 mg/L, HR: 1.86, 95% CI: 1.09-3.16; P = 0.023), and highest quintiles (≥12.56 mg/L, HR: 2.02, 95% CI: 1.21-3.36; P = 0.007) of postprocedural hsCRP, compared to the second lowest quintile (2.26-4.85 mg/L). RCS analysis depicted a J-shaped association between postprocedural hsCRP and mortality (P for nonlinearity = 0.004). Similar association was observed between hsCRP and cardiac death (P for nonlinearity = 0.014), but not for noncardiac mortality (P for nonlinearity = 0.228). Conclusions Both low and high postprocedural hsCRP were associated with higher risk of death in ACS patients treated by PCI.
Highlights
High-sensitivity C-reactive protein, a sensitive serum marker of acute and chronic systemic inflammation [1, 2], is closely associated with outcomes of patients with various types of coronary heart diseases (CHD), including stable CHD and myocardial infarction (MI), and those undergoing percutaneous coronary intervention (PCI) [3,4,5,6]
Few studies have evaluated the prognostic value of postprocedural high-sensitivity C-reactive protein (hsCRP) after PCI in patients with acute coronary syndromes (ACS), which makes therapeutic
Among the 3940 ACS patients treated by PCI, the mean age was 59:0 ± 11:9 years old, and 3105 (78.8%) patients were male (Table 1)
Summary
High-sensitivity C-reactive protein (hsCRP), a sensitive serum marker of acute and chronic systemic inflammation [1, 2], is closely associated with outcomes of patients with various types of coronary heart diseases (CHD), including stable CHD and myocardial infarction (MI), and those undergoing percutaneous coronary intervention (PCI) [3,4,5,6]. The widely used PCI procedures could cause further myocardial damage and result in significant elevation of hsCRP [10, 11]. In this scenario, postprocedural hsCRP might be more appropriate for evaluating the inflammatory response caused by acute coronary events and relevant treatments. This study is aimed at investigating the probable nonlinear association between postprocedural hsCRP and mortality in patients with acute coronary syndromes (ACS) treated by percutaneous coronary intervention (PCI).
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