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Canadian Journal of Cardiology

Prognostic Value of Baseline Inflammation in Diabetic and Nondiabetic Patients Undergoing Percutaneous Coronary Intervention

Published:February 10, 2022DOI:https://doi.org/10.1016/j.cjca.2022.02.002

      Abstract

      Background

      There is a paucity of data on the prognostic value of high-sensitivity C-reactive protein (hsCRP) levels in diabetic and nondiabetic patients undergoing percutaneous coronary intervention (PCI).

      Methods

      All patients with known baseline hsCRP undergoing PCI at a single tertiary care centre from 2010 to 2017 were included. High hsCRP was defined as > 3 mg/L. Known causes of elevated hsCRP levels and hsCRP > 10 mg/L represented exclusion criteria. The 1-year primary outcome was major adverse cardiovascular events (MACE), including all-cause mortality, myocardial infarction (MI), and target-vessel revascularisation (TVR).

      Results

      Among a total of 11,979 patients included, high hsCRP levels were observed in 24.7% of patients without diabetes and 29.8% of patients with diabetes (P < 0.001). Both diabetics and nondiabetics with high hsCRP levels had increased rates of MACE compared with their counterparts with low hsCRP (diabetics: adjusted hazard ratio [aHR] 1.58, 95% CI 1.27-1.96; nondiabetics: aHR 1.45, 95% CI 1.13-1.86; P interaction = 0.981) primarily driven by increased rates all-cause deaths (diabetics: aHR 2.32, 95% CI 1.42-3.80; nondiabetics: aHR 3.14, 95% CI 1.74-5.65; P interaction = 0.415). Although high hsCRP levels were associated with increased rates of TVR (aHR 1.35, 95% CI 1.04-1.75) and MI (aHR 1.86, 95% CI 1.18-2.93) only in patients with diabetes, no significant interactions were observed between inflammation and diabetes (P interaction = 0.749 and 0.602, respectively).

      Conclusions

      Patients undergoing PCI with high levels of hsCRP, defined as > 3 mg/L, have worse ischemic outcomes regardless of diabetes status.

      Résumé

      Contexte

      Il existe peu de données sur la valeur pronostique des taux de protéine C-réactive de haute sensibilité (PCR-hs) chez les patients diabétiques et non diabétiques devant subir une intervention coronarienne percutanée (ICP).

      Méthodologie

      L’étude portait sur tous les patients dont le taux de PCR-hs initial était connu, qui ont subi une ICP dans un seul centre de soins tertiaires entre 2010 et 2017. Par définition, un taux élevé de PCR-hs était > 3 mg/L. Les taux élevés de PCR-hs dus à des causes connues et les taux de PCR-hs > 10 mg/L faisaient partie des critères d’exclusion. Le principal critère d’évaluation après un an incluait les événements cardiovasculaires indésirables majeurs (ECIM), y compris la mortalité toutes causes confondues, l’infarctus du myocarde et la revascularisation du vaisseau cible.

      Résultats

      Parmi les 11 979 patients inclus, les taux de PCR-hs étaient élevés chez 24,7 % des patients non diabétiques et 29,8 % des patients diabétiques (p < 0,001). Les ECIM étaient plus fréquents chez les diabétiques et les non-diabétiques présentant des taux élevés de PCR-hs comparativement à leurs homologues dont les taux de PCR-hs étaient faibles (diabétiques : rapport des risques instantanés corrigé [RRIc] de 1,58; IC à 95 % : 1,27-1,96; non-diabétiques : RRIc de 1,45; IC à 95 % : 1,13-1,86; pinteraction = 0,981). La fréquence de ces ECIM était principalement attribuable aux taux accrus de décès toutes causes confondues (diabétiques : RRIc de 2,32; IC à 95 % : 1,42-3,80; non-diabétiques : RRIc de 3,14; IC à 95 % : 1,74-5,65; pinteraction = 0,415). Bien que les taux élevés de PCR-hs aient été associés à des taux accrus de revascularisation du vaisseau cible (RRIc de 1,35; IC à 95 % : 1,04-1,75) et d’infarctus du myocarde (RRIc de 1,86; IC à 95 % : 1,18-2,93) seulement chez les patients diabétiques, aucune interaction significative n’a été observée entre l’inflammation et le diabète (pinteraction = 0,749 et 0,602, respectivement).

      Conclusions

      Les résultats ischémiques sont plus défavorables chez les patients qui doivent subir une ICP s’ils présentent des taux élevés de PCR-hs (définis par un taux > 3 mg/L), indépendamment du statut diabétique.

      Graphical abstract

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