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

Yixuan Duan; Miaohan Qiu; Kun Na; Daoshen Liu; Shangxun Zhou; Ying Xu; Zizhao Qi; Haiwei Liu; Kai Xu; Xiaozeng Wang; Jing Li; Yi Li; Yaling Han

doi:10.1055/a-2531-3268

Thrombosis and Haemostasis, Table of Contents

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^*

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

²The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China

,

Miaohan Qiu^*

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Kun Na

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Daoshen Liu

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

²The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China

,

Shangxun Zhou

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

²The Department of Cardiology, Air Force Medical University, Xijing Hospital, Xi'an, Shaanxi, China

,

Ying Xu

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Zizhao Qi

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Haiwei Liu

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Kai Xu

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Xiaozeng Wang

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Jing Li

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Yi Li

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

,

Yaling Han

¹Department of Cardiology, State Key Laboratory of Frigid Zone Cardiovascular Disease, General Hospital of Northern Theater Command, Shenyang, China

› Author Affiliations

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

Full Text

References

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Supplementary Material

Supplementary Material