Abstract

Background: Triglycerides (TG) denote residual triglyceride risk (RTR) while hsCRP indicates residual inflammatory risk (RIR) and both are associated with adverse cardiovascular events. Question: In patients undergoing PCI with optimally managed LDL cholesterol (LDL-C), what are the contributions of RTR and RIR to cardiovascular risk? Aim: To investigate the associations of RTR and RIR with major adverse cardiac events (MACE) in patients undergoing PCI with optimal LDL-C levels. Methods: We evaluated consecutive patients with optimal LDL-C (<70 mg/dL) undergoing PCI at a large tertiary center between 2012 and 2022. Patients were categorized into four subgroups according to baseline TG and hsCRP: (i) No residual risk (hsCRP <2 mg/L + TG <150 mg/dL); (ii) RTR alone (hsCRP <2 mg/L + TG ≥150 mg/dL); (iii) RIR alone (hsCRP >2 mg/L + TG <150 mg/dL); (iv) Combined RIR and RTR (hsCRP ≥2 mg/L+ TG ≥150 mg/dL). Known causes of elevated hsCRP and hsCRP > 10 mg/L were exclusion criteria. The primary outcome was MACE, defined as a composite of all-cause mortality, myocardial infarction, or stroke. A Cox regression model adjusted for multiple covariates was performed to analyze outcomes using patients without residual risk as a reference. Results: A total of 9,446 patients were included in the analysis. Of these, 5,339 showed no residual risk, 3,009 RIR only, 555 RTR only, and 543 exhibited a combination of RIR and RTR. After adjustment, RIR was significantly associated with an increased risk of MACE independently of RTR (p<0.001, adj. HR: 1.80, 95% CI: 1.41-2.29 for no RTR and p=0.002, adj. HR: 1.90, 95% CI: 1.27-2.86 for RTR). This was primarily driven by all-cause mortality. Conversely, in patients with only RTR, MACE and all-cause death rates were numerically higher but risk estimates were not statistically significant after adjustment ( Figure 1 ). Conclusions: Among patients undergoing PCI with optimally managed LDL-C, RIR was associated with an increased risk of MACE, while RTR did not impact outcomes. HsCRP may be used over TG to stratify the risk for adverse cardiovascular events after PCI.