P214 PROGNOSTIC IMPACT OF RESIDUAL INFLAMMATORY RISK AFTER ACUTE CORONARY SYNDROME

Abstract

Abstract Background Recent randomized clinical trials have shown that an anti–inflammatory treatment may reduce the recurrence of cardiovascular events in association with traditional secondary prevention measures. Aim: The aim of this observational retrospective study based on patients with acute coronary syndrome (ACS), treated with high intensity statins and undergoing an early invasive strategy, was to evaluate the incidence of residual inflammatory risk after 1 month, its possible determinants and its association with the medium–long term prognosis. Methods We selected patients with ACS without ST segment elevation (ACS–NSTEMI) admitted to our hospital from June 2015 to June 2018 who had a complete biochemical examination at 1 month after the acute event. All these patients were included in the PRATO–ACS Registry (ClinicalTrials.gov ID: NCT04087200). All–cause mortality was analyzed within 3 years. Residual inflammatory risk (RIR) was defined as 1–month high sensitivity C reactive protein (hs–CRP) value > 2 mg/l. The association between 1–month hs–CRP and 3–year all–cause mortality was expressed by hazard ratio (HR) and 95% confidence interval (CI). Results The study group consisted of 739 patients (mean age 68 ± 12 years, male 68.3%, mean hospital stay 5 ± 2 days) all treated with high intensity statins (rosuvastatin 20–40 mg or atorvastatin 40–80 mg) immediately upon admission and scheduled for early invasive strategy (74.5% underwent PCI). At baseline 525 patients (71%) had hs–CRP values ≥ 2 mg/l and 568 (77%) LDL cholesterol levels > 100 mg/dl. The incidence of RIR was 58.7%, with no significant differences between patients with LDL <or> 70 mg/dl. Lipid profile (LDL > 100 mg/dl, HDL < 40mg/dl in man and < 50mg/dl in woman), hs–CRP > 2 mg/l, the left ventricular ejection fraction < 40% and glomerular filtration rate <60 ml/min/m2 were independently associated with RIR. Multivariate analysis showed that RIR was an independent predictor of 3–year all–cause mortality (HR = 2.15 (95% CI 1.06–4.33; p = 0.03)) while LDL cholesterol > 70 mg/dl did not (HR = 0.98 95% (CI 0.50–1.91; p = 0.9)). Conclusions In a population of ACS patients treated with high intensity statins and an early invasive therapeutic strategy, the incidence of RIR (hs–CRP ≥ 2 mg/l) at 1 month after ACS is high (58.7%). The RIR is associated with a higher baseline clinical risk profile and was an independent predictor of 3 year all–cause mortality regardless of achieved LDL values.