Abstract 4360589: A New Comprehensive Parameter Residual C-Reactive Protein And Neutrophil Risk Predict Adverse Events In Chinese Patients After Percutaneous Coronary Intervention: a National Multi-Center Prospective Cohort Study

Abstract

Objectives: High-sensitivity C-reactive protein (hsCRP) and the neutrophil-lymphocyte ratio (NLR) are independent and validated inflammatory markers that predict cardiovascular events in patients after percutaneous coronary intervention (PCI). Residual C reactive protein and neutrophil risk (RCNR) post-PCI, especially in East Asian populations with a baseline lower level of inflammation requires comprehensive evaluation. Methods: This prospective, multi-center cohort study included 2376 patients aged 18-80 years who completed the planned PCI. Inflammation status was assessed with hsCRP and NLR measurements at baseline before PCI and at 1-month post PCI. Patients were stratified into four groups according to the median of 1-month hsCRP and NLR levels: No RCNR (hsCRP<1 mg/L and NLR<2.4), RNR (residual neutrophil risk, hsCRP<1 mg/L and NLR≥2.4), RCR (residual C reactive protein risk, hsCRP≥1 mg/L and NLR<2.4), and RCNR (hsCRP≥1 mg/L and NLR≥2.4). The primary endpoint was major adverse cardiovascular and cerebrovascular event (MACCE), defined as the composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, and revascularization due to ischemia at the 12-month follow-up. Results: The mean age of the patients in the total cohort was 60.8 ± 9.8 years, and 28.5% of the patients were female. The median hsCRP level was 1.0 mg/L, and the median NLR was 2.4 at the 1-month follow-up. The MACCE rates in patients with RCNR (7.2%) were significantly higher than those in patients with No RCNR (2.5%), RNR (5.5%) or RCR (5.4%). After full adjustment of risk factors, patients with RNR, RCR, and RCNR have increasingly higher risk for MACCE (the hazard ratios [HR] and 95% confidence intervals [CI] were: 1.95 (1.07-3.57), 2.09 (1.14-3.82), and 2.29 (1.30-4.05), respectively, with no RCNR group as the reference. Conclusions: RCNR at 1-month follow-up, a residual inflammatory risk index including hsCRP and NLR using different cut-off value than standard in Caucasian populations, reflects the inflammatory status of Chinese patients after PCI and correlates with future risk of adverse cardiovascular events.