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已发表论文
非阻塞性冠状动脉心肌梗死患者中残余炎症风险及持续性炎症的意义
Authors Gao S, Huang S, Liu X, Yu M, Li W
Received 17 June 2025
Accepted for publication 27 September 2025
Published 6 October 2025 Volume 2025:18 Pages 13855—13868
DOI https://doi.org/10.2147/JIR.S547594
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Qing Lin
Side Gao,1 Sizhuang Huang,2 Xinming Liu,1 Mengyue Yu,2 Weiming Li1
1Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
Correspondence: Weiming Li; Mengyue Yu, Email liweiming@sina.com; yumy73@163.com
Background: Inflammation as assessed by high-sensitivity C-reactive protein (hs-CRP) predicts cardiovascular outcomes independently of low-density lipoprotein cholesterol (LDL-C) levels even in statin-treated patients with coronary artery disease. However, data regarding implications of residual inflammatory risk in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) are lacking.
Methods: The present single-center cohort study prospectively enrolled 1062 patients with MINOCA stratified by the baseline hs-CRP (≥ 2 vs < 2 mg/L) and LDL-C (≥ 70 vs < 70 mg/dL). Change patterns of hs-CRP were identified in 792 patients with available hs-CRP at baseline and within 6– 12 months after index MI. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure.
Results: During the median follow-up of 41.7 months, patients with isolated residual inflammatory risk had the highest rate of MACE, followed by patients with combined cholesterol and inflammatory risk. At multivariate Cox model, residual inflammatory risk but not cholesterol risk was associated with an increased risk of MACE compared to those with no residual risk [hazard ratio (HR) 1.51; 95% confidence interval (CI): 1.17– 1.97, p=0.002]. The prognostic impact of hs-CRP ≥ 2mg/L remained significant in subgroup analysis, and particularly, in patients with well-managed LDL-C levels. Patients with persistently higher hs-CRP had a significantly higher risk of MACE than those with persistently low hs-CRP (HR 1.28; 95% CI: 1.09– 1.50, p=0.020).
Conclusion: Residual inflammation but not cholesterol risk drives poorer outcomes after MINOCA in the statin era, highlighting inflammation as a pivotal risk predictor and the necessity for anti-inflammatory strategies alongside LDL-C lowering.
Keywords: residual risk, inflammation, hs-CRP, LDL-C, myocardial infarction with nonobstructive coronary arteries, cardiovascular outcomes
1Heart Center and Beijing Key Laboratory of Hypertension, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, People’s Republic of China; 2Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, People’s Republic of China
Correspondence: Weiming Li; Mengyue Yu, Email liweiming@sina.com; yumy73@163.com
Background: Inflammation as assessed by high-sensitivity C-reactive protein (hs-CRP) predicts cardiovascular outcomes independently of low-density lipoprotein cholesterol (LDL-C) levels even in statin-treated patients with coronary artery disease. However, data regarding implications of residual inflammatory risk in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) are lacking.
Methods: The present single-center cohort study prospectively enrolled 1062 patients with MINOCA stratified by the baseline hs-CRP (≥ 2 vs < 2 mg/L) and LDL-C (≥ 70 vs < 70 mg/dL). Change patterns of hs-CRP were identified in 792 patients with available hs-CRP at baseline and within 6– 12 months after index MI. The primary endpoint was major adverse cardiovascular events (MACE), a composite of death, nonfatal MI, stroke, revascularization, and hospitalization for unstable angina or heart failure.
Results: During the median follow-up of 41.7 months, patients with isolated residual inflammatory risk had the highest rate of MACE, followed by patients with combined cholesterol and inflammatory risk. At multivariate Cox model, residual inflammatory risk but not cholesterol risk was associated with an increased risk of MACE compared to those with no residual risk [hazard ratio (HR) 1.51; 95% confidence interval (CI): 1.17– 1.97, p=0.002]. The prognostic impact of hs-CRP ≥ 2mg/L remained significant in subgroup analysis, and particularly, in patients with well-managed LDL-C levels. Patients with persistently higher hs-CRP had a significantly higher risk of MACE than those with persistently low hs-CRP (HR 1.28; 95% CI: 1.09– 1.50, p=0.020).
Conclusion: Residual inflammation but not cholesterol risk drives poorer outcomes after MINOCA in the statin era, highlighting inflammation as a pivotal risk predictor and the necessity for anti-inflammatory strategies alongside LDL-C lowering.
Keywords: residual risk, inflammation, hs-CRP, LDL-C, myocardial infarction with nonobstructive coronary arteries, cardiovascular outcomes