LOCAL coronary inflammation appeared to predict adverse outcomes after percutaneous coronary intervention (PCI) more strongly than systemic inflammation, according to new research presented at EuroPCR 2026.
Local Inflammation and PCI Risk
Researchers from Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China, analysed 2,075 patients with coronary artery disease who underwent PCI and pre-procedural coronary CT angiography. The team assessed local vascular inflammation using pericoronary fat attenuation index (FAI), while systemic inflammation was measured using high-sensitivity C-reactive protein (hs-CRP).
Over a median follow-up of 3 years, 174 patients experienced major adverse cardiovascular events (MACE), including all-cause mortality, non-fatal myocardial infarction, or unplanned repeat revascularisation. Patients with higher levels of local inflammation consistently showed significantly greater risk of poor outcomes after PCI.
Among the different coronary inflammation markers assessed, FAI-MAX emerged as the strongest predictor of adverse events. After multivariable adjustment, patients with elevated FAI-MAX had more than three-times higher risk of MACE compared with those with lower values (hazard ratio [HR]: 3.20; 95% CI: 2.28–4.50; p<0.001). A machine learning model also identified FAI-MAX as the most important inflammatory variable.
Local and Systemic Inflammation Increased MACE Risk
Researchers found that combining local and systemic inflammatory markers identified patients at particularly high risk of adverse cardiovascular events following PCI. Patients with both high FAI-MAX and elevated hs-CRP had the highest risk of MACE (HR: 4.18; 95% CI: 2.64–6.62; p<0.001).
Notably, even patients with low systemic inflammation remained at increased risk if local coronary inflammation was elevated. Those with high FAI-MAX but low hs-CRP had substantially higher event risk than patients with elevated systemic inflammation alone.
This finding suggested that local vascular inflammation may be more clinically relevant than circulating inflammatory markers when assessing post-PCI prognosis.
Local Coronary Inflammation May Guide Future PCI Care
PCI remains one of the most widely performed procedures for coronary artery disease worldwide, yet identifying patients at greatest risk of recurrent events remains challenging.
The researchers suggested that integrating the measurement of both local inflammation with systemic inflammation could improve patient stratification and potentially support more personalised inflammation-guided management strategies after PCI.
Further studies will now be needed to determine how local coronary inflammation assessment could be integrated into routine clinical practice and whether inflammation-guided treatment strategies can improve outcomes after PCI
Reference
Ye Z, Dou K. Comparative impact of local and systemic inflammation on outcomes following PCI. Abstract A97191ZY, EuroPCR 2026, 19-22 May, 2026.
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