Residual inflammatory risk at 12 months after acute coronary syndromes is frequent and associated with combined adverse events.

Klingenberg, Roland; Aghlmandi, Soheila; Gencer, Baris; Nanchen, David; Räber, Lorenz; Carballo, David; Carballo, Sebastian; Stähli, Barbara E; Landmesser, Ulf; Rodondi, Nicolas; Mach, François; Windecker, Stephan; Bucher, Heiner C; von Eckardstein, Arnold; Lüscher, Thomas F; Matter, Christian M (2021). Residual inflammatory risk at 12 months after acute coronary syndromes is frequent and associated with combined adverse events. Atherosclerosis, 320, pp. 31-37. Elsevier 10.1016/j.atherosclerosis.2021.01.012

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BACKGROUND AND AIMS

Residual inflammatory risk (RIR) after acute coronary syndromes (ACS) may identify patients likely to benefit from anti-inflammatory therapies.

METHODS

Patients from the Special Program University Medicine ACS cohort were divided into four groups according to level of hsCRP at baseline and after 12 months: persistently high RIR, increased RIR (first low, then high hsCRP), attenuated RIR (first high, then low hsCRP), or persistently low RIR. High RIR was defined as hsCRP ≥ 2 mg/L. An independently adjudicated incident of combined adverse events was defined as the composite of myocardial infarction, clinically indicated coronary revascularization or cerebrovascular events.

RESULTS

Among 1209 patients with available hsCRP, clinical and demographic data, 295 (24.4%) patients had persistently high RIR (delta hsCRP median (IQR): 2.3 (-9.9; 0.3) (mg/L) and 72 (5.96%) patients had increased RIR (delta hsCRP median (IQR): +2.45 (1.2; 8.35) (mg/L). A total of 390 (32.26%) patients had attenuated RIR (delta hsCRP median (IQR): 3.55 (-10; -2) (mg/L) and 452 (37.38%) patients had persistently low RIR (delta hsCRP median (IQR): 0.2 (-0.6; 0.1) (mg/L). Of 90 combined adverse events, 31 (10.5%) occurred in the persistently high (multivariable adjusted OR: 1.71, (95% CI 1.08-2.7), p = 0.022) compared with the three other groups combined (increased RIR: 3 (4.2%), attenuated RIR 30 (7.7%), persistently low RIR 26 (5.8%).

CONCLUSIONS

Persistently elevated hsCRP after ACS is found in a quarter of patients with the highest risk of combined adverse events. This underlines the need to perform anti-inflammatory intervention trials in RIR patients.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Räber, Lorenz; Rodondi, Nicolas and Windecker, Stephan

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0021-9150

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

11 Feb 2021 09:44

Last Modified:

07 Mar 2021 01:37

Publisher DOI:

10.1016/j.atherosclerosis.2021.01.012

PubMed ID:

33524907

Uncontrolled Keywords:

Biomarkers CRP Inflammation Myocardial infarction Risk factors

BORIS DOI:

10.48350/152145

URI:

https://boris.unibe.ch/id/eprint/152145

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