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Abstract：
BACKGROUND: Residual risk assessment for acute coronary syndrome (ACS) patients after sufficient medical management remains challenging. The usefulness of measuring high-sensitivity C-reactive protein (hsCRP) and remnant cholesterol (RC) in assessing the level of residual inflammation risk (RIR) and residual cholesterol risk (RCR) for risk stratification in these patients needs to be evaluated.
METHODS: Patients admitted for ACS on statin treatment who underwent percutaneous coronary intervention (PCI) between March 2016 and March 2019 were enrolled in the analysis. The included patients were stratified based on the levels of hsCRP and RC during hospitalization. The primary outcome was ischemic events at 12 months, defined as a composite of cardiac death, myocardial infarction, or stroke. The secondary outcomes included 12-month all-cause death and cardiac death.
RESULTS: Among the 5778 patients, the median hsCRP concentration was 2.60 mg/L and the median RC concentration was 24.98 mg/dL. The RIR was significantly associated with ischemic events (highest hsCRP tertile vs. lowest hsCRP tertile, adjusted hazard ratio [aHR]: 1.52, 95% confidence interval [CI]: 1.01-2.30, P = 0.046), cardiac death (aHR: 1.77, 95% CI:1.02-3.07, P = 0.0418) and all-cause death (aHR: 2.00, 95% CI: 1.24-3.24, P = 0.0048). The RCR was also significantly associated with these outcomes, with corresponding values for the highest tertile of RC were 1.81 (1.21-2.73, P = 0.0043), 2.76 (1.57-4.86, P = 0.0004), and 1.72 (1.09-2.73, P = 0.0208), respectively. The risks of ischemic events (aHR: 2.80, 95% CI: 1.75-4.49, P < 0.0001), cardiac death (aHR: 4.10, 95% CI: 2.18-7.70, P < 0.0001), and all-cause death (aHR: 3.00, 95% CI, 1.73-5.19, P < 0.0001) were significantly greater in patients with both RIR and RCR (highest hsCRP and RC tertile) than in patients with neither RIR nor RCR (lowest hsCRP and RC tertile). Notably, the RIR and RCR was associated with an increased risk of ischemic events especially in patients with adequate low-density lipoprotein cholesterol (LDL-C) control (LDL-C < 70 mg/dl) (Pinteraction=0.04). Furthermore, the RIR and RCR provide more accurate evaluations of risk in addition to the GRACE score in these patients [areas under the curve (AUC) for ischemic events: 0.64 vs. 0.66, P = 0.003].
CONCLUSIONS: Among ACS patients receiving contemporary statin treatment who underwent PCI, high risks of both residual inflammation and cholesterol, as assessed by hsCRP and RC, were strongly associated with increased risks of ischemic events, cardiac death, and all-cause death.
METHODS: Patients admitted for ACS on statin treatment who underwent percutaneous coronary intervention (PCI) between March 2016 and March 2019 were enrolled in the analysis. The included patients were stratified based on the levels of hsCRP and RC during hospitalization. The primary outcome was ischemic events at 12 months, defined as a composite of cardiac death, myocardial infarction, or stroke. The secondary outcomes included 12-month all-cause death and cardiac death.
RESULTS: Among the 5778 patients, the median hsCRP concentration was 2.60 mg/L and the median RC concentration was 24.98 mg/dL. The RIR was significantly associated with ischemic events (highest hsCRP tertile vs. lowest hsCRP tertile, adjusted hazard ratio [aHR]: 1.52, 95% confidence interval [CI]: 1.01-2.30, P = 0.046), cardiac death (aHR: 1.77, 95% CI:1.02-3.07, P = 0.0418) and all-cause death (aHR: 2.00, 95% CI: 1.24-3.24, P = 0.0048). The RCR was also significantly associated with these outcomes, with corresponding values for the highest tertile of RC were 1.81 (1.21-2.73, P = 0.0043), 2.76 (1.57-4.86, P = 0.0004), and 1.72 (1.09-2.73, P = 0.0208), respectively. The risks of ischemic events (aHR: 2.80, 95% CI: 1.75-4.49, P < 0.0001), cardiac death (aHR: 4.10, 95% CI: 2.18-7.70, P < 0.0001), and all-cause death (aHR: 3.00, 95% CI, 1.73-5.19, P < 0.0001) were significantly greater in patients with both RIR and RCR (highest hsCRP and RC tertile) than in patients with neither RIR nor RCR (lowest hsCRP and RC tertile). Notably, the RIR and RCR was associated with an increased risk of ischemic events especially in patients with adequate low-density lipoprotein cholesterol (LDL-C) control (LDL-C < 70 mg/dl) (Pinteraction=0.04). Furthermore, the RIR and RCR provide more accurate evaluations of risk in addition to the GRACE score in these patients [areas under the curve (AUC) for ischemic events: 0.64 vs. 0.66, P = 0.003].
CONCLUSIONS: Among ACS patients receiving contemporary statin treatment who underwent PCI, high risks of both residual inflammation and cholesterol, as assessed by hsCRP and RC, were strongly associated with increased risks of ischemic events, cardiac death, and all-cause death.
摘要：
背景：对急性冠脉综合征（ACS）患者进行充分医疗管理后的剩余风险评估仍然具有挑战性。需要评估高敏C反应蛋白（hsCRP）和残余胆固醇（RC）在评估这些患者的残余炎症风险（RIR）和残余胆固醇风险（RCR）水平以进行风险分层中的有用性。
方法：在2016年3月至2019年3月期间接受他汀类药物治疗的ACS患者接受了经皮冠状动脉介入治疗（PCI）。根据住院期间的hsCRP和RC水平对纳入的患者进行分层。主要结果是12个月时的缺血事件，定义为心脏死亡的复合物，心肌梗塞,或中风。次要结局包括12个月的全因死亡和心脏死亡。
结果：在5778名患者中，hsCRP浓度中位数为2.60mg/L,RC浓度中位数为24.98mg/dL.RIR与缺血事件显着相关（最高hsCRP与最低hsCRP三元，调整后的风险比[AHR]：1.52，95%置信区间[CI]：1.01-2.30，P=0.046)，心源性死亡(aHR:1.77,95%CI:1.02-3.07,P=0.0418)和全因死亡(aHR:2.00,95%CI:1.24-3.24,P=0.0048)。RCR也与这些结果显着相关，RC最高三分位数的相应值为1.81（1.21-2.73，P=0.0043），2.76(1.57-4.86,P=0.0004),和1.72（1.09-2.73，P=0.0208），分别。缺血性事件的风险（aHR：2.80，95％CI：1.75-4.49，P<0.0001），心源性死亡（AHR：4.10，95%CI：2.18-7.70，P<0.0001），RIR和RCR患者（hsCRP和RC最高）的全因死亡（aHR：3.00，95％CI，1.73-5.19，P<0.0001）明显高于RIR和RCR患者（hsCRP和RC最低）。值得注意的是,RIR和RCR与缺血事件风险增加相关,尤其是在低密度脂蛋白胆固醇(LDL-C)得到充分控制(LDL-C<70mg/dl)的患者中(P-interaction=0.04).此外，除了这些患者的GRACE评分外，RIR和RCR还提供了更准确的风险评估[缺血事件的曲线下面积（AUC）：0.64vs.0.66,P=0.003]。
结论：在接受现代他汀类药物治疗并接受PCI的ACS患者中，残余炎症和胆固醇的风险很高，由hsCRP和RC评估，与缺血事件风险增加密切相关，心脏死亡,和全因死亡。
方法：在2016年3月至2019年3月期间接受他汀类药物治疗的ACS患者接受了经皮冠状动脉介入治疗（PCI）。根据住院期间的hsCRP和RC水平对纳入的患者进行分层。主要结果是12个月时的缺血事件，定义为心脏死亡的复合物，心肌梗塞,或中风。次要结局包括12个月的全因死亡和心脏死亡。
结果：在5778名患者中，hsCRP浓度中位数为2.60mg/L,RC浓度中位数为24.98mg/dL.RIR与缺血事件显着相关（最高hsCRP与最低hsCRP三元，调整后的风险比[AHR]：1.52，95%置信区间[CI]：1.01-2.30，P=0.046)，心源性死亡(aHR:1.77,95%CI:1.02-3.07,P=0.0418)和全因死亡(aHR:2.00,95%CI:1.24-3.24,P=0.0048)。RCR也与这些结果显着相关，RC最高三分位数的相应值为1.81（1.21-2.73，P=0.0043），2.76(1.57-4.86,P=0.0004),和1.72（1.09-2.73，P=0.0208），分别。缺血性事件的风险（aHR：2.80，95％CI：1.75-4.49，P<0.0001），心源性死亡（AHR：4.10，95%CI：2.18-7.70，P<0.0001），RIR和RCR患者（hsCRP和RC最高）的全因死亡（aHR：3.00，95％CI，1.73-5.19，P<0.0001）明显高于RIR和RCR患者（hsCRP和RC最低）。值得注意的是,RIR和RCR与缺血事件风险增加相关,尤其是在低密度脂蛋白胆固醇(LDL-C)得到充分控制(LDL-C<70mg/dl)的患者中(P-interaction=0.04).此外，除了这些患者的GRACE评分外，RIR和RCR还提供了更准确的风险评估[缺血事件的曲线下面积（AUC）：0.64vs.0.66,P=0.003]。
结论：在接受现代他汀类药物治疗并接受PCI的ACS患者中，残余炎症和胆固醇的风险很高，由hsCRP和RC评估，与缺血事件风险增加密切相关，心脏死亡,和全因死亡。
