Residual Cardiovascular Biomarkers After Medical Therapy and Their Prognostic Implications Following Percutaneous Coronary Intervention

BACKGROUND: Despite medical therapy, atherothrombotic events remain common in high-risk patients with coronary artery disease. OBJECTIVES: The purpose of this study was to evaluate the association between atherothrombotic biomarkers and outcomes in patients with coronary artery disease who are undergoing percutaneous coronary intervention (PCI). METHODS: Biomarkers including lipid profile (low-density lipoprotein cholesterol and triglycerides), inflammation (high-sensitivity C-reactive protein [hs-CRP]), platelet reactivity (P2Y12 reaction unit), and coagulation (fibrinogen) were measured on admission and at 1 month following medical therapy post-PCI (n = 2,789). The primary endpoint was major adverse cardiovascular events, defined as a composite of cardiovascular death, myocardial infarction, or stroke, occurring between 1 month and 4 years post-PCI. RESULTS: Biomarker levels decreased significantly (all P values ≤ 0.001), except for fibrinogen levels (329 ± 86 vs 359 ± 92 mg/dL; P < 0.001). The median follow-up of the participants was 2.2 years (IQR: 1.3-4.0 years). Covariate-adjusted HRs for the lowest to highest quartiles were 1.00 (referent) (95% CI), 1.37 (0.78-2.41), 1.89 (1.11-3.21), and 1.71 (1.01-2.91) for 1-month hs-CRP; and 1.00 (referent), 1.49 (0.83-2.67), 1.83 (1.03-3.26), and 2.47 (1.40-4.36) for 1-month fibrinogen. Among these biomarkers, hs-CRP and fibrinogen levels at 1 month showed the highest correlation (r = 0.426). After adjusting for covariates and biomarkers, the 1-month fibrinogen level was the strongest incremental predictor of major adverse cardiovascular event (HRs: 1.00 [referent], 1.45 [0.80-2.62], 1.65 [0.91-2.98], and 2.23 [1.20-4.12], P < 0.001). CONCLUSIONS: Among medically treated patients following PCI, elevated fibrinogen levels were associated with adverse outcomes. Further studies are warranted to clarify these associations and to determine whether adjunctive therapies can improve outcomes in this high-risk group. (Gyeongsang National University Hospital [GNUH] Registry; NCT04650529).