Clinical impact of systemic inflammation across different high-sensitivity C-reactive protein cutoffs in patients undergoing percutaneous coronary intervention

Background and aims Systemic inflammation enhances coronary atherosclerosis progression and is assessed by high-sensitivity C-reactive protein (hsCRP). However, heterogeneity exists in defining the optimal hsCRP threshold associated with increased cardiovascular risk. Here we evaluated the impact of inflammation in patients with CAD undergoing percutaneous coronary intervention (PCI) using different cutoffs of hsCRP elevation. Methods We conducted a retrospective analysis of patients undergoing PCI from 2012 to 2022 at Mount Sinai Hospital (NY, USA). Patients were stratified according to commonly used thresholds of baseline hsCRP. The primary endpoint was MACCE, defined as the composite of all-cause mortality, myocardial infarction, or stroke. Results Of 10,811 patients included, 6210 (57.4 %) had hsCRP <2 mg/L, 1624 (15.0 %) between 2 and 3 mg/L, and 2977 (27.6 %) > 3 mg/L. Increased rates of MACCE were observed in each group with elevated hsCRP using both the hsCRP = 3 mg/L (4.9 % vs. 2.6 %; p < 0.001) and hsCRP = 2 mg/L thresholds (4.4 % vs. 2.4 %; p < 0.001). The risk of MACCE was also higher in patients with hsCRP values between 2 and 3 mg/L (HR: 1.44, 95 % CI 1.03-2.00; p = 0.032). For both thresholds, the receiver operating characteristic (ROC) curve showed similar ability to predict MACCE. Conclusions In patients undergoing PCI, hsCRP values above both established thresholds of 2 and 3 mg/L predict an increased risk of 1-year MACCE, but neither threshold was superior in predicting cardiovascular risk. Patients with hsCRP between 2 and 3 mg/L have increased event rates compared to patients with hsCRP below 2 mg/L.