Nearly a third of patients who had a stent after a myocardial infarction would remain at risk of recurrence due to a residual inflammatory risk. Evaluated on a simple blood test, this over-risk could be the subject of a specific treatment.
During a heart attack, patients who have persistent inflammation following coronary angioplasty with stent placement have a much higher risk of dying or having a reheart attack within a year. following.
This would be the risk linked to the residual inflammatory risk according to a study on 7026 patients published in the European Heart Journal.
Negative role of inflammation
Residual inflammatory risk refers to the risk of later heart problems caused by persistent inflammation in patients with known coronary artery disease.
A biological assay, that of ultra-sensitive C-reactive protein (CRPus), can be used as an indicator of the level of this risk. Until this study, it was not known what proportion of patients treated with angioplasty had a high and persistent residual inflammatory risk, and what effect this might have on the prognosis of these patients.
One in 4 patients concerned
Researchers at Mount Sinai Medical Center, New York, USA, looked at data from patients who had angioplasty at this hospital between 2009 and 2016. Of the 7,026 patients, 2,654 (38%) had a risk persistent high residual inflammatory risk, 719 (10%) had an increased residual inflammatory risk, 1088 (15%) had an attenuated residual inflammatory risk and 2565 (37%) had a persistent low residual inflammatory risk. One year after stent placement, 2.6% of patients with a persistent high residual inflammatory risk, 1% of those with a high, 0.3% of patients with an attenuated residual inflammatory risk and 0.7% patients with a low residual inflammatory risk had died. Myocardial infarctions occurred in 7.5%, 6.4%, 4.6% and 4.3% of patients, respectively.
A differentiating inflammatory criterion
After adjusting the results for various confounding factors, such as age, sex, body mass index, diabetes, high blood pressure and other conditions, the researchers show that, compared to patients at risk of inflammation Low and Persistent Residual Inflammatory Risk Patients at the highest persistent and high residual inflammatory risk are three times more likely to die within a year of any cause and were 1.6 times more likely to have a heart attack.
In patients who have received a stent to dilate coronary artery stenosis and cover atherosclerotic plaque, and for whom serial measurements of ultra-sensitive CRP are available, almost 40% of them are at risk high and persistent residual inflammatory disease. Moreover, this residual inflammatory risk is associated with a higher risk of dying or having a heart attack in the year following the placement of the stent.
Atherogenic role of inflammation
This discovery is not insignificant because new strategies have been tested in a cardiovascular context to reduce the residual inflammatory risk. Indeed, in a recent test, CANTOS (Canakinumab anti-inflammatory thrombosis outcome study) in patients with a history of heart attack and high ultra-sensitive CRP, an anti-IL1 monoclonal antibody, canakinumab, by targeting inflammation, it reduces the number death from cardiovascular disease, stroke, myocardial infarction and major adverse cardiac events.
This study underscores that coronary artery disease is not a uniform disease, but rather there are different categories of risk profiles, which could benefit from more individualized treatment than “packaged” treatment. current. It is therefore necessary for clinicians to assess all residual risks after stent placement, not just cholesterol, smoking and high blood pressure. This study provides further evidence of the importance of measuring ultra-sensitive CRP in patients at risk in order to better individualize treatment.
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