Coronary disease & ACS

Local vs systemic inflammation and outcomes after percutaneous coronary intervention

Eur Heart JPublished Prospective cohort study

Authors' conclusion

Local coronary inflammation shows a stronger association with adverse outcomes after PCI than systemic inflammation. Integrating both markers improves risk stratification and may support inflammation-guided management in patients with CAD.

Study context

Population
Patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI)
Participants
1,987 patients2,436 vessels
Exposure
Local coronary inflammation vs systemic inflammation
Outcome
MACE:
  • All-cause mortality
  • Non-fatal MI
  • Unplanned repeat revascularization
Follow-up
median 3-year follow-up

Main finding

As reported in the abstract

MACE
Hazard ratio (95% CI)
High FAI-MAXvs Low FAI-MAX
3.25(2.29–4.61)
High FAI-MAX + elevated hs-CRPhighest risk
4.00(2.47–6.32)
High local + low systemic inflammation
2.88(1.85–4.49)
Low local + high systemic inflammation
1.09(0.55–1.85)
Patients with major adverse cardiovascular events (MACE)
164 (8.3%)

Observational data: associations, not effects.

Further findings

OutcomeHR (95% CI)
VOCE (vessel level) · median 3-year follow-upHigh FAI-MAXvs Low FAI-MAX3.15 (2.06–4.82)

Vessel-oriented composite endpoint (VOCE) (vessel level) · median 3-year follow-up

HR (95% CI)
High FAI-MAX + elevated hs-CRP4.15 (2.37–7.25)
High local + low systemic inflammation2.64 (1.55–4.50)
Low local + high systemic inflammation1.08 (0.55–2.13)
VOCE (vessel level) — Vessels with VOCE
118 of 2,436 (4.8%)

Model discrimination

Both markers improved discrimination vs either alone
DeLong P < 0.05

Sensitivity analysis excluding revascularization

Advantage of isolated high FAI-MAX attenuated; dual-high phenotype remained significant

Original publication

Local vs systemic inflammation and outcomes after percutaneous coronary intervention. Eur Heart J. Published 29 August 2026. doi:10.1093/eurheartj/ehag731

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