P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention

Objective This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk. Methods A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke. Results A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up. Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251 Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462 Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016 Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897 Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors. Combined cholesterol/inflammatory risk Conclusion AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.