Relationship between serial c-reactive protein levels and cardiovascular events in East asian patients treated with percutaneous coronary intervention

초록

Background: The CANTOS trial demonstrated that canakinumab can significantly reduce the risk of recurrent cardiovascular (CV) events in MI survivors with the high level of hs-CRP (≥2 mg/L). East Asians have shown the lower levels of inflammation surrogates compared with Western population, and it remains uncertain how the high-risk East Asian patients can be properly selected using the level of hs-CRP.Methods: Serial hs-CRP levels (on-admission and one-month post-PCI) were measured in 3,324 patients undergoing PCI. Patients were stratified into 4 groups according to hs-CRP cutoff of 2 mg/L: (1) persistent low hs-CRP (n=1,845, 55.5%); (2) high on-admission/low one-month hs-CRP (n=673, 20.2%); (3) low on-admission/high one-month hs-CRP (n=203, 6.1%); and (4) persistent high hs-CRP (n=603, 18.1%). MACE was defined as a composite of CV death, non-fatal MI, and ischemic stroke.Results: With a median follow-up of 35.7 (IQR: 17.2, 55.9) months, MACE was occurred in 7.0% of the cohort. Compared with on-admission hs-CRP values, one-month follow-up measures were decreased (median 1.2 [IQR: 0.5, 3.7] vs. median 0.8 [IQR 0.4, 1.9], p<0.001). The persistent high group showed the increased risk of MACE compared with other groups (log-rank test, p<0.0001) (Figure). After adjustment, the persistent high group remained significantly higher in terms with the occurrence of MACE (HR, 2.46; 95% CI, 1.69 to 3.57; p<0.001).Conclusion: This is the first study to show that serial measurement of hs-CRP level can help to choose the high-risk patients following PCI. About one-fifth of East Asian patients may be the good candidate favoring the use of anti-inflammatory agents such as the canakinumab following PCI.