Long-term Impact of Residual Inflammatory Risk in Acute Myocardial Infarction Patients Treated With Percutaneous Coronary Intervention Who Achieved Optimal Lipid Control.

Background

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Objectives

This study aimed to evaluate the prognostic impact of high residual inflammatory risk (RIR) in patients with acute myocardial infarction (AMI) who underwent percutaneous coronary intervention (PCI) and achieved optimal low-density lipoprotein cholesterol (LDL-C) control.

Methods

A retrospective analysis was conducted on successfully revascularized AMI patients from a large, prospective, multi-center PCI registry between 2004 and 2014. Patients with LDL-C ≤70 mg/dL at 1-year follow up and serial high-sensitivity C-reactive protein (hsCRP) measurements at baseline and 1 year were included. High RIR was defined as hsCRP >2 mg/L at 1 year. The primary endpoint was all-cause mortality, and secondary endpoints were major adverse cardiac and cerebrovascular events (MACCE).

Results

Of the 661 patients, 129 (19.5%) had high RIR. Over a median follow up of 5.3 years, the high RIR group had significantly higher mortality rates (43.1 per 1,000 patient-years) compared to the low RIR group (10.9 per 1,000 patient-years; p<0.001). After multivariable adjustment, high RIR remained independently associated with increased mortality (adjusted hazard ratio [HR], 3.41; 95% confidence interval [CI], 1.80-6.45; p<0.001) and a higher risk of MACCE (adjusted HR, 3.08; 95% CI, 1.90-4.99; p<0.001). The associations between high RIR and adverse outcomes were also consistent in the subgroup with LDL-C ≤55 mg/dL.

Conclusions

In stabilized AMI patients with optimal LDL-C control after PCI, high RIR is a significant prognostic factor for adverse events. Reducing residual inflammation may improve long-term outcomes following PCI in these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02806102.