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CC BY 4.0 · Thromb Haemost
DOI: 10.1055/a-2531-3268
Blood Cells, Inflammation and Infection

Inflammatory and Bleeding Risks on Clinical Outcomes in Acute Coronary Syndrome Patients Undergoing Percutaneous Coronary Intervention

Yixuan Duan   *
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Miaohan Qiu   *
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Kun Na
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Daoshen Liu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Shangxun Zhou
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
2   The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China
,
Ying Xu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Zizhao Qi
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Haiwei Liu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Kai Xu
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Xiaozeng Wang
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Jing Li
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Yi Li
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
,
Yaling Han
1   Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China
› Institutsangaben Funding This work was supported by grants from the National Key Research and Development Program of China (2022YFC2503503 and 2022YFC2503504).
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Abstract

Objective

This study aimed to evaluate the impact of systemic inflammation burden using high-sensitivity C-reactive protein (hsCRP) and long-term prognosis in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) stratified by bleeding risk status.

Methods

Consecutive patients admitted for ACS and who received PCI between March 2016 and March 2022 were enrolled in the analysis. Elevated systemic inflammation was defined as hsCRP >2 mg/L, and high bleeding risk (HBR) was defined the Academic Research Consortium (ARC)-HBR criteria. The primary outcome was ischemic events at 12 months, composed of cardiac death, myocardial infarction, and/or stroke. The main secondary outcomes included all-cause death, and Bleeding Academic Research Consortium (BARC) types 2, 3, and 5 bleeding and types 3 and 5 bleeding.

Results

Of 15,013 patients, 4,606 (30.7%) were qualified as HBR and 8,395 (55.9%) had hsCRP >2 mg/L. Elevated hsCRP was consistently associated with higher risk of ischemic events in both HBR (adjusted hazard ratio [aHR]: 1.20; 95% confidence interval [CI]: 0.91–1.58) and non-HBR (aHR: 1.34; 95% CI: 1.01–1.78) subgroups (P interaction = 0.755). Although the incidence of bleeding events was higher in HBR patients, an elevated hsCRP level was not associated with bleeding events regardless of HBR status. Restricted cubic spline regression represented an inverse J-shaped relation between hsCRP and non-HBR for ischemic events (P nonlinearity <0.001) and all-cause death (P nonlinearity = 0.003).

Conclusion

Regardless of HBR status, high levels of hsCRP were associated with an increased risk of ischemic events and all-cause death in ACS patients following PCI, but not for bleeding.

Keywords

acute coronary syndrome - high bleeding risk - high-sensitivity C-reactive protein - inflammation

Ethical Approval Statement

This study was approved by the institutional ethical committee of the General Hospital of Northern Theater Command with a waiver of the requirement to obtain informed consent. The study also complied with the provisions of the Declaration of Helsinki.


Data Availability Statement

The data that support the findings of this study are available from the corresponding author, upon reasonable request.


Authors' Contribution

D.Y.X. and M.H.Q. were responsible equally for writing the original draft, methodology, data curation, formal analysis, and visualization. K.N., D.S.L., S.X.Z., X.Y., Z.Z.Q., H.W.L., K.X., X.Z.W., and J.L. were responsible for the investigation. Y.L. was responsible for conceptualization, methodology, data curation, and project administration. Y.L.H. was responsible for conceptualization, funding acquisition, data curation, project administration, methodology, and supervision. All authors read and approved the final manuscript.


* These authors contributed equally to this work.


Supplementary Material



Publikationsverlauf

Eingereicht: 29. November 2024

Angenommen: 31. Januar 2025

Accepted Manuscript online:
04. Februar 2025

Artikel online veröffentlicht:
13. März 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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  • References

  • 1 Bay B, Vogel B, Sharma R. et al. Inflammatory risk and clinical outcomes according to polyvascular atherosclerotic disease status in patients undergoing PCI. Clin Res Cardiol 2024; . Epub ahead of print
    CrossrefPubMedSuche in Google Scholar
  • 2 Mahmoud AK, Farina JM, Awad K. et al. Lipoprotein(a) and long-term in-stent restenosis after percutaneous coronary intervention. Eur J Prev Cardiol 2024; 31 (15) 1878-1887
    CrossrefPubMedSuche in Google Scholar
  • 3 Alkhalil M, Kuzemczak M, Zhao R. et al. Prognostic role of residual thrombus burden following thrombectomy: insights from the TOTAL trial. Circ Cardiovasc Interv 2022; 15 (05) e011336
    CrossrefPubMedSuche in Google Scholar
  • 4 Byrne RA, Rossello X, Coughlan JJ. et al; ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2024; 13 (01) 55-161
    CrossrefPubMedSuche in Google Scholar
  • 5 Ridker PM, Everett BM, Thuren T. et al; CANTOS Trial Group. Antiinflammatory therapy with canakinumab for atherosclerotic disease. N Engl J Med 2017; 377 (12) 1119-1131
    CrossrefPubMedSuche in Google Scholar
  • 6 Tardif JC, Kouz S, Waters DD. et al. Efficacy and safety of low-dose colchicine after myocardial infarction. N Engl J Med 2019; 381 (26) 2497-2505
    CrossrefPubMedSuche in Google Scholar
  • 7 Nidorf SM, Fiolet ATL, Mosterd A. et al; LoDoCo2 Trial Investigators. Colchicine in patients with chronic coronary disease. N Engl J Med 2020; 383 (19) 1838-1847
    CrossrefPubMedSuche in Google Scholar
  • 8 Bouabdallaoui N, Tardif JC, Waters DD. et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J 2020; 41 (42) 4092-4099
    CrossrefPubMedSuche in Google Scholar
  • 9 Ridker PM, MacFadyen JG, Glynn RJ, Bradwin G, Hasan AA, Rifai N. Comparison of interleukin-6, C-reactive protein, and low-density lipoprotein cholesterol as biomarkers of residual risk in contemporary practice: secondary analyses from the Cardiovascular Inflammation Reduction Trial. Eur Heart J 2020; 41 (31) 2952-2961
    CrossrefPubMedSuche in Google Scholar
  • 10 Liao J, Qiu M, Su X. et al. The residual risk of inflammation and remnant cholesterol in acute coronary syndrome patients on statin treatment undergoing percutaneous coronary intervention. Lipids Health Dis 2024; 23 (01) 172
    CrossrefPubMedSuche in Google Scholar
  • 11 Vinayak M, Cao D, Tanner R. et al. Impact of bleeding risk and inflammation on cardiovascular outcomes after percutaneous coronary intervention. JACC Cardiovasc Interv 2024; 17 (03) 345-355
    CrossrefPubMedSuche in Google Scholar
  • 12 Chen R, Liu C, Zhou P. et al. Both low and high postprocedural hsCRP associate with increased risk of death in acute coronary syndrome patients treated by percutaneous coronary intervention. Mediators Inflamm 2020; 2020: 9343475
    CrossrefPubMedSuche in Google Scholar
  • 13 Urban P, Mehran R, Colleran R. et al. Defining high bleeding risk in patients undergoing percutaneous coronary intervention: a consensus document from the Academic Research Consortium for High Bleeding Risk. Circulation 2019; 140 (03) 240-261
    CrossrefPubMedSuche in Google Scholar
  • 14 Nanchen D, Klingenberg R, Gencer B. et al. Inflammation during acute coronary syndromes—risk of cardiovascular events and bleeding. Int J Cardiol 2019; 287: 13-18
    CrossrefPubMedSuche in Google Scholar
  • 15 Sarnak MJ, Amann K, Bangalore S. et al; Conference Participants. Chronic kidney disease and coronary artery disease: JACC state-of-the-art review. J Am Coll Cardiol 2019; 74 (14) 1823-1838
    CrossrefPubMedSuche in Google Scholar
  • 16 Zheng Y, Huang Y, Li H. Hemoglobin albumin lymphocyte and platelet score and all-cause mortality in coronary heart disease: a retrospective cohort study of NHANES database. Front Cardiovasc Med 2023; 10: 1241217
    CrossrefPubMedSuche in Google Scholar
  • 17 Qiu M, Na K, Qi Z. et al. Contemporary use of ticagrelor vs clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention: a GRACE risk score stratification-based analysis in a large-scale, real-world study from China. Mayo Clin Proc 2023; 98 (07) 1021-1032
    CrossrefPubMedSuche in Google Scholar
  • 18 Na K, Qiu M, Ma S. et al. Impact of ticagrelor vs. clopidogrel in patients with acute coronary syndrome undergoing percutaneous coronary intervention after risk stratification with the CHA2DS2-VASc score. Front Cardiovasc Med 2022; 9: 808571
    CrossrefPubMedSuche in Google Scholar
  • 19 Ahn J-H, Tantry US, Kang MG. et al. Residual inflammatory risk and its association with events in East Asian patients after coronary intervention. JACC Asia 2022; 2 (03) 323-337
    CrossrefPubMedSuche in Google Scholar
  • 20 Costa F, van Klaveren D, James S. et al; PRECISE-DAPT Study Investigators. Derivation and validation of the predicting bleeding complications in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score: a pooled analysis of individual-patient datasets from clinical trials. Lancet 2017; 389 (10073): 1025-1034
    CrossrefPubMedSuche in Google Scholar
  • 21 Yu M, Yuan Y-F, Yang F. et al. Residual inflammatory risk in outcomes of Chinese patients after percutaneous coronary intervention. JACC Asia 2024; 4 (08) 636-638
    CrossrefPubMedSuche in Google Scholar
  • 22 Pearson TA, Mensah GA, Alexander RW. et al; Centers for Disease Control and Prevention, American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107 (03) 499-511
    CrossrefPubMedSuche in Google Scholar
  • 23 Montalto C, Munafò AR, Arzuffi L. et al. Validation of the ARC-HBR criteria in 68,874 patients undergoing PCI: a systematic review and meta-analysis. Hellenic J Cardiol 2022; 66: 59-66
    CrossrefPubMedSuche in Google Scholar
  • 24 Nakamura M, Kadota K, Nakao K. et al. High bleeding risk and clinical outcomes in East Asian patients undergoing percutaneous coronary intervention: the PENDULUM registry. EuroIntervention 2021; 16 (14) 1154-1162
    CrossrefPubMedSuche in Google Scholar
  • 25 Gragnano F, Spirito A, Corpataux N. et al. Impact of clinical presentation on bleeding risk after percutaneous coronary intervention and implications for the ARC-HBR definition. EuroIntervention 2021; 17 (11) e898-e909
    CrossrefPubMedSuche in Google Scholar
  • 26 Du X, Guo L, Xia S. et al. Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China. Heart 2021; 107 (07) 535-541
    CrossrefPubMedSuche in Google Scholar
  • 27 Hamanaka Y, Sotomi Y, Hirata A. et al. Persistent systemic inflammation is associated with bleeding risk in atrial fibrillation patients. Circ J 2020; 84 (03) 411-418
    CrossrefPubMedSuche in Google Scholar
  • 28 Steinvil A, Rogowski O, Banai S. et al. Anemia and inflammation have an additive value in risk stratification of patients undergoing coronary interventions. J Cardiovasc Med (Hagerstown) 2015; 16 (02) 106-111
    CrossrefPubMedSuche in Google Scholar
  • 29 Ridker PM, Tuttle KR, Perkovic V, Libby P, MacFadyen JG. Inflammation drives residual risk in chronic kidney disease: a CANTOS substudy. Eur Heart J 2022; 43 (46) 4832-4844
    CrossrefPubMedSuche in Google Scholar
  • 30 Libby P, Kobold S. Inflammation: a common contributor to cancer, aging, and cardiovascular diseases-expanding the concept of cardio-oncology. Cardiovasc Res 2019; 115 (05) 824-829
    CrossrefPubMedSuche in Google Scholar
  • 31 Attizzani GF, Capodanno D, Ohno Y, Tamburino C. Mechanisms, pathophysiology, and clinical aspects of incomplete stent apposition. J Am Coll Cardiol 2014; 63 (14) 1355-1367
    CrossrefPubMedSuche in Google Scholar
  • 32 Tucker B, Vaidya K, Cochran BJ, Patel S. Inflammation during percutaneous coronary intervention-prognostic value, mechanisms and therapeutic targets. Cells 2021; 10 (06) 1391
    CrossrefPubMedSuche in Google Scholar
  • 33 Laudani C, Occhipinti G, Greco A, Giacoppo D, Spagnolo M, Capodanno D. A pairwise and network meta-analysis of anti-inflammatory strategies after myocardial infarction: the TITIAN study. Eur Heart J Cardiovasc Pharmacother 2025; pvae100
    CrossrefPubMedSuche in Google Scholar
  • 34 Yu M, Yang Y, Dong SL. et al. Effect of Colchicine on Coronary Plaque Stability in Acute Coronary Syndrome as Assessed by Optical Coherence Tomography: The COLOCT Randomized Clinical Trial. Circulation 2024; 150 (13) 981-993
    CrossrefPubMedSuche in Google Scholar
  • 35 Kawada-Watanabe E, Yamaguchi J, Sekiguchi H, Arashi H, Ogawa H, Hagiwara N. Targeting high-sensitivity C-reactive protein levels in acute coronary syndrome patients undergoing contemporary lipid-lowering therapy: a sub-analysis of the HIJ-PROPER trial. J Cardiol 2020; 75 (05) 500-506
    CrossrefPubMedSuche in Google Scholar
  • 36 Takahashi N, Dohi T, Endo H. et al. Residual inflammation indicated by high-sensitivity C-reactive protein predicts worse long-term clinical outcomes in Japanese patients after percutaneous coronary intervention. J Clin Med 2020; 9 (04) 1033
    CrossrefPubMedSuche in Google Scholar
  • 37 Kim SE, Jeon HS, Go TH. et al; PTRG-DES consortium investigators. High platelet reactivity combined with CYP2C19 genotype in predicting outcomes in East Asian patients undergoing percutaneous coronary intervention. Clin Pharmacol Ther 2023; 114 (05) 1104-1115
    CrossrefPubMedSuche in Google Scholar
  • 38 Feng J, Wu Y. Interleukin-35 ameliorates cardiovascular disease by suppressing inflammatory responses and regulating immune homeostasis. Int Immunopharmacol 2022; 110: 108938
    CrossrefPubMedSuche in Google Scholar
  • 39 Wang H, Liu Z, Shao J. et al. Immune and inflammation in acute coronary syndrome: molecular mechanisms and therapeutic implications. J Immunol Res 2020; 2020: 4904217
    CrossrefPubMedSuche in Google Scholar
  • 40 Kelly PJ, Lemmens R, Tsivgoulis G. Inflammation and stroke risk: a new target for prevention. Stroke 2021; 52 (08) 2697-2706
    CrossrefPubMedSuche in Google Scholar
  • 41 Li Y, Li J, Wang B. et al; OPT-BIRISK Investigators. Extended clopidogrel monotherapy vs DAPT in patients with acute coronary syndromes at high ischemic and bleeding risk: the OPT-BIRISK randomized clinical trial. JAMA Cardiol 2024; 9 (06) 523-531
    CrossrefPubMedSuche in Google Scholar
  • 42 Kim HK, Tantry US, Smith Jr SC. et al. The East Asian paradox: an updated position statement on the challenges to the current antithrombotic strategy in patients with cardiovascular disease. Thromb Haemost 2021; 121 (04) 422-432
    Thieme ConnectPubMedSuche in Google Scholar