Breaking News
February 20, 2019 - New screening tool more likely to identify sexual and labor exploitation of youth
February 20, 2019 - Newly licensed nurses work for long hours, also have a second paid job
February 20, 2019 - Physicists identify simple mechanism used by deadly bacteria to fend off antibiotics
February 20, 2019 - FDA Grants Priority Review to Genentech’s Personalized Medicine Entrectinib
February 20, 2019 - Exposure to chemicals before and after birth is associated with a decrease in lung function
February 20, 2019 - Neuroscientists reveal that simple brain region can guide complex feats of mental activity
February 20, 2019 - Study finds new link between food allergies and multiple sclerosis
February 20, 2019 - First gene therapy operation for macular degeneration is a success
February 20, 2019 - Physicians graduated outside the U.S. offer better care for Medicare patients with complex needs
February 20, 2019 - FDA Approves Keytruda (pembrolizumab) for the Adjuvant Treatment of Patients with Melanoma with Involvement of Lymph Node(s) Following Complete Resection
February 20, 2019 - Study identifies brain cells that modulate behavioral response to threats
February 20, 2019 - Researchers take closer look at how viruses bind cells and cause infection
February 20, 2019 - Newly developed gene therapy helps decelerate aging process
February 20, 2019 - Study suggests new treatment strategy for deadly brain cancer
February 20, 2019 - Scientists develop unique hybrid implant that imitates bone structure
February 20, 2019 - Push-ups can be tailored to meet specific needs of individuals
February 20, 2019 - CVD Does Not Modify Depression-Mortality Link in Elderly
February 20, 2019 - Electrical activity early in fruit flies’ brain development could shed light on how neurons wire the brain
February 20, 2019 - Machine learning technique helps predict which asthma patients respond to corticosteroid therapy
February 20, 2019 - Self-reported sleep duration is a useful tool to measure sleep in children, study suggests
February 20, 2019 - T-cells play key role in how the body fights follicular lymphoma
February 20, 2019 - Study shows how 3D organization of genetic material helps perpetuate the species
February 20, 2019 - Researchers engineer stem cell with ‘suicide genes’ to induce cell death in all but beta cells
February 20, 2019 - Study reveals major sex differences in management of cardiovascular risk factors among U.S. adults
February 20, 2019 - Health Tip: Get Your Child to School on Time
February 20, 2019 - Shortcut strategy for screening compounds with clinical potentials for drug development
February 20, 2019 - Common acid reflux drugs tied to elevated risk for kidney disease
February 20, 2019 - Microbiome could be culprit when good drugs do harm
February 20, 2019 - Prenatal exposure to forest fires causes stunted growth in children
February 20, 2019 - Gene therapy restores hearing in mice with congenital genetic deafness
February 20, 2019 - First molecular test predicts treatment response for kidney cancer
February 20, 2019 - New method for improved visualization of single-cell RNA- sequencing data
February 20, 2019 - Researchers capture altered brain activity patterns of Parkinson’s in mice
February 20, 2019 - A possible blood test for detecting Alzheimer’s disease before symptoms show
February 20, 2019 - Primary care physicians associated with longevity, new research finds
February 19, 2019 - New study identifies many key lessons to establish sanctioned safe consumption sites
February 19, 2019 - Single CRISPR treatment can safely and stably correct genetic disease
February 19, 2019 - Multinational initiative to study familial primary distal renal tubular acidosis
February 19, 2019 - Breakthrough study highlights the promise of cell therapies for muscular dystrophy
February 19, 2019 - Subsymptom Threshold Exercise Speeds Concussion Recovery
February 19, 2019 - Midline venous catheters – infants: MedlinePlus Medical Encyclopedia
February 19, 2019 - Searching for side effects
February 19, 2019 - Humanity is all right, probably, although human extinction remains quite possible, researcher says
February 19, 2019 - Having Anesthesia Once as a Baby Does Not Cause Learning Disabilities, New Research Shows
February 19, 2019 - Anti-cancer immunotherapy could be used to fight HIV
February 19, 2019 - Customized Micropatterning for Improved Physiological Relevance
February 19, 2019 - Unique gene therapy approach paves new way to tackle rare, inherited diseases
February 19, 2019 - Activating gene that helps excite neurons reverses depression in male mice
February 19, 2019 - Science Puzzling Out Differences in Gut Bacteria Around the World
February 19, 2019 - Cells that destroy the intestine
February 19, 2019 - On recovery, vulnerability and ritual: An exhibit in white
February 19, 2019 - Scientific Duo Gets Back To Basics To Make Childbirth Safer
February 19, 2019 - COPD patients need more support when understanding new chest symptoms
February 19, 2019 - Using light-based method for production of pharmaceutical molecules
February 19, 2019 - Scientists find link between inflammation and cancer
February 19, 2019 - The High Cost Of Sex: Insurers Often Don’t Pay For Drugs To Treat Problems
February 19, 2019 - Hearing impairment associated with accelerated cognitive decline with age
February 19, 2019 - Researchers identify multiple genetic variants associated with body fat distribution
February 19, 2019 - Influenza and common cold are completely different diseases, study shows
February 19, 2019 - Scientists untangle how microbes manufacture key antibiotic compound
February 19, 2019 - Greater primary care physician supply associated with longer life spans
February 19, 2019 - HIV-1 protein suppresses immune response more broadly than thought
February 19, 2019 - Brain imaging indicates potential success of drug therapy in depressive patients
February 19, 2019 - For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It
February 19, 2019 - Specialized lung cells appear in the developing fetus much earlier than previously thought
February 19, 2019 - KU professor discusses promise of brain-computer interface to aid, restore communication
February 19, 2019 - Highly effective solution for detecting onset of aggregation in nanoparticles
February 19, 2019 - Early marker of cardiac damage triggered by cancer treatment identified
February 19, 2019 - Antidepressant drug could save people from deadly sepsis, research suggests
February 19, 2019 - CRISPR technology creates pluripotent stem cells that are ‘invisible’ to the immune system
February 19, 2019 - New study establishes how stress favors breast cancer growth and spread
February 19, 2019 - Midlife Systemic Inflammation Linked to Later Cognitive Decline
February 19, 2019 - Therapy derived from parasitic worms downregulates proinflammatory pathways
February 19, 2019 - Antimicrobial reusable coffee cups are less likely to become contaminated with bacteria, study shows
February 19, 2019 - Harnessing the evolutionary games played by cancer cells to advance therapies
February 19, 2019 - AHA News: Heart Transplant Survivor Gets Wedding Proposal at Finish Line
February 19, 2019 - HIV hidden in patients’ cells can now be accurately measured
February 19, 2019 - Research finds reasons for sudden cardiac death in patients with stable ischemic disease
February 19, 2019 - New protocol could help physicians to rule out bacterial infections in infants
February 19, 2019 - Women experiencing miscarriage should be offered treatment choices
Study reveals impact of residual inflammatory risk on clinical outcomes after PCI

Study reveals impact of residual inflammatory risk on clinical outcomes after PCI

image_pdfDownload PDFimage_print

Patients who have persistently high levels of inflammation following percutaneous coronary intervention (PCI) for coronary artery disease are significantly more likely to die from any cause or to have a heart attack within a year, according to a study of 7,026 patients published in the European Heart Journal.

Residual inflammatory risk (RIR) refers to the risk of further heart and blood vessel problems caused by vascular inflammation in patients with known coronary artery disease. A biological marker – high sensitivity C-reactive protein (hsCRP) – is used as an indicator of the level of risk. Until now it has not been known what proportion of patients treated with PCI to widen blocked arteries have persistent high RIR, and what effect it might have on patient outcomes.

In the first study to investigate the prevalence of persistent high RIR after PCI, researchers led by Professor Roxana Mehran, from the Mount Sinai Medical Center, New York, USA, looked at data from patients who had received PCI at Mount Sinai Hospital between 2009 and 2016. They included all patients who had two measurements of hsCRP taken at the time of the PCI and then again at least four weeks later.

Patients were stratified into four groups according to their RIR: high RIR was defined as having levels of hsCRP of more than 2mg per liter of blood. If both measurements were high, then they were considered to have persistent high RIR; patients with a high first measurement, but then a low second measurement were considered to have attenuated RIR; those with a low and then high measurement had an increased RIR; and those whose measurements were both low had a low persistent low RIR.

Of the 7,026 patients, 2,654 (38%) had persistent high RIR, 719 (10%) had increased RIR, 1,088 (15%) had attenuated RIR, and 2,565 (37%) had persistent low RIR. One year after PCI, death from any cause had occurred in 2.6% of persistent high RIR patients, 1% of increased RIR patients, 0.3% of attenuated RIR patients and 0.7% of persistent low RIR patients. Heart attacks (myocardial infarction) occurred in 7.5%, 6.4%, 4.6% and 4.3% of the patients, respectively.

After adjusting for various factors that could affect the results, such as age, gender, body mass index, diabetes, high blood pressure and other conditions, the researchers found that compared to patients with persistent low RIR, persistent high RIR patients were more than three times more likely to die within one year from any cause and were 1.6 times as likely to have a heart attack.

Professor Mehran said: “Our results show that in patients for whom serial hsCRP measurements were available, more than a third of PCI patients had persistent high residual inflammatory risk. Moreover, cardiologists are clearly not evaluating residual inflammatory status in all patients after PCI. This should be considered, as we find it is associated with a higher risk of dying from any cause or suffering a heart attack within one year of PCI. Additionally, it is of interest because there are treatment strategies emerging aimed at lowering residual inflammatory risk.”

She pointed to the results of a recent trial, CANTOS (Canakinumab Anti-inflammatory Thrombosis Outcomes Study), that found that a monoclonal antibody, canakinumb, which reduces hsCRP, significantly reduced deaths from cardiovascular disease, stroke, myocardial infarction, and reduced the incidence of major adverse cardiac events in patients who had a history of heart attacks and elevated hsCRP.

“The results of the CANTOS study were astonishing. Not only a reduction in hsCRP was found, but more importantly a significant reduction in heart attack, stroke or cardiovascular death was found in patients who took canakinumab. It is clearly important to identify the patients at highest risk who can benefit from the therapy, and to evaluate this in a prospective study. I do believe that we need data from randomized controlled trials to confirm our observational findings in patients undergoing PCI and with persistent high residual inflammatory risk.

“Our study emphasizes that treating patients with coronary artery disease is not ‘one-size-fits-all’. Patients fall into different risk categories and it’s the clinicians’ task to evaluate all residual risks after PCI. I hope that in the future we will be able to treat all patients according to their own individual risk profile.”

Professor Paul Ridker, Director of the Center for Cardiovascular Disease Prevention at the Brigham and Women’s Hospital, Boston, USA, who is an expert on inflammation in heart disease, developing the clinical application of hsCRP testing to evaluate cardiovascular risk and leading the CANTOS trial, has written an accompanying Viewpoint article with European colleagues, which is published today (Monday) [3]. He writes that while European clinicians “enthusiastically measure cholesterol and blood pressure in virtually all of their patients, surprisingly few measure high sensitivity C-reactive protein (hsCRP), a validated measure of cardiovascular inflammation”.

He writes that the current study provides yet more evidence of the importance of measuring hsCRP to prevent further cardiovascular problems, and concludes: “Physicians can only address the biologic processes they measure. Without assessment of LDL cholesterol, it is impossible to effectively identify and manage hyperlipidemia. Without knowledge of systolic and diastolic blood pressure, it is impossible to effectively identify and manage hypertension. Without measuring hsCRP, it is unclear how we will effectively identify and manage residual inflammatory risk. while today the management of the residual inflammatory risk involves more aggressive and guideline-based treatment of the currently known risk factors, the introduction of effective anti-inflammatory drugs in the near future will provide even better control of this residual risk.”

Limitations of Prof Mehran’s study include that it is observational; however, the hsCRP measurements were collected at the time of PCI and during follow-up, but were evaluated retrospectively rather than in a standardized prospective way.

Source:

https://www.escardio.org/

Tagged with:

About author

Related Articles