Effect of Temporal Trend in Inflammatory and Cholesterol Risk on the Prognosis of Percutaneous Coronary Intervention-Treated Patients with Contemporary Statin Therapy

Abstract Background: Atherosclerotic cardiovascular disease patients still suffer from recurrent vascular events due to residual cholesterol and inflammatory risk. However, the relative importance of inflammation and cholesterol risk might have changed in percutaneous coronary intervention (PCI)-treated patients after accepting contemporary statin therapy. Hence, this study aims to evaluate the effect of temporal trend in inflammatory and cholesterol risk on the prognosis of that population. Methods: PCI-treated patients at Fuwai Hospital between 1st January 2016 and 31st December 2017 with on-admission and follow-up high-sensitive C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C) within 1 to 3 months were retrospectively enrolled. Participants were all taking contemporary statin treatment at discharge. Tertiles of on-admission and follow-up hs-CRP (a biomarker for inflammatory risk) and LDL-C (a biomarker for cholesterol risk) were assessed as determinants of one-year major adverse cardiovascular and cerebrovascular events (MACCEs). Multivariable Cox proportional hazard model was used to evaluate the prognostic value of on-admission, follow-up cholesterol and inflammatory risk. High inflammatory or cholesterol risk after accepting contemporary statins were expressed as residual cholesterol risk (RCR), residual inflammatory risk (RIR) and residual cholesterol and inflammatory risk (RCIR). Subgroup analysis of inflammatory and cholesterol risk on admission was conducted based on the glycometabolic status, index presentation and guideline-recommended statin therapy (GRST) at discharge. Results: After one-year of follow-up, 187 MACCEs occurred in 2373 participants. Among the on-admission and follow-up hsCRP and LDL-C tetiles, only the follow-up LDL-C tertile failed to predict the occurrence of MACCEs [T3 versus T1, adjusted hazard ratio (HR) 0.89, 95% confidence interval (CI) 0.61-1.29, P=0.544]. After adjusting for various confounding factors, on-admission high cholesterol and inflammatory risk was significantly associated with the incidence of MACCEs (HR 2.45 95%CI 2.45 1.42-4.21, P<0.001). RIR can be a major determinant of MACCEs (adjusted HR 4.43, 95% CI 2.82-6.98, P<0.001). Subgroup analysis showed the potential predictive role of on-admission high inflammatory risk only for MACCEs in those with diabetes mellitus (HR 2.35, 95% CI 1.01-5.43) and accepting underpowered statins at discharge (HR 2.16, 95% CI 1.05-4.41). Conclusion: We observed a combined effect of on-admission high cholesterol and inflammatory risk that could predict the risk of MACCEs. Inflammatory risk assessed by hs-CRP was a stronger predictor for MACCEs than cholesterol risk assessed by LDL-C in PCI-treated patients after taking contemporary statin therapy. Additionally, on-admission high inflammatory risk only could independently predict cardiovascular outcomes in PCI-treated patients with diabetes mellitus and accepting underpowered statin therapy. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study has been approved by the ethics committee of Fuwai Hospital (No. 2021-1063). The informed consent from participants was waived by the Ethics Committee.The authors declare that they have no competing interests I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets and materials mentioned above are available from the authors on reasonable requests