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Inflammasome and Immune Disorders / Adipokines, Inflammation, and Metabolic Diseases · Journal article
Korean Circulation Journal · September 7, 2026
Encouraging direction, but not yet definitive.
This observational cohort study found that 19.5% of post-MI patients had persistent high hsCRP (>2 mg/L) at 1 year, which was independently associated with a 3- to 4-fold increase in mortality and major adverse cardiac events over 5 years, even among those achieving LDL <55 mg/dL. The finding supports the residual inflammatory risk hypothesis but does not establish whether targeting this biomarker improves outcomes, nor does it resolve the recent neutral result of the CLEAR-SYNERGY colchicine trial.
Observational cohort study. Post-acute myocardial infarction patients with serial high-sensitivity C-reactive protein measurements available at 1 year.. Compared with: High residual inflammatory risk (hsCRP >2 mg/L at 1 year) versus standard/low risk (hsCRP ≤2 mg/L at 1 year). n = 661.
19.5% of 661 post-MI patients had high residual inflammatory risk (hsCRP >2 mg/L at 1 year) High RIR associated with adjusted HR 3.41 for all-cause mortality over median 5.3 years follow-up High RIR associated with adjusted HR 3.08 for major adverse cardiac and cerebrovascular events
High RIR associated with adjusted HR 3.41 for all-cause mortality over median 5.3 years follow-up High RIR associated with adjusted HR 3.08 for major adverse cardiac and cerebrovascular events
The findings suggest that hsCRP measured at 1 year post-MI may identify a high-risk subgroup warranting closer monitoring or intensified therapy, even when LDL targets are achieved. However, the clinician should note that recent anti-inflammatory trials (CLEAR-SYNERGY) have failed to demonstrate benefit and the optimal therapeutic target remains unsettled.
A single-centre observational study with serial biomarker measurements demonstrating a clear association between residual inflammatory risk and clinical outcomes in post-MI patients, but lacking a randomized design or intervention to establish causation or guide treatment.
As stated by the source record.
Quoted from the source exactly as published.
The findings suggest that hsCRP measured at 1 year post-MI may identify a high-risk subgroup warranting closer monitoring or intensified therapy, even when LDL targets are achieved. However, the clinician should note that recent anti-inflammatory trials (CLEAR-SYNERGY) have failed to demonstrate benefit and the optimal therapeutic target remains unsettled.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Numerous strategies have been studied to improve clinical outcomes after acute myocardial infarction (AMI), and the most firmly established is low-density lipoprotein (LDL) cholesterol-lowering therapy.Contemporary dyslipidemia guidelines therefore recommend intensive LDL-lowering after AMI, with an European Society of Cardiology/European Atherosclerosis Society and American College of Cardiology/American Heart Association goal of below 55 mg/dL together with at least a 50% reduction from baseline in very-high-risk patients.1)2) Yet despite aggressive LDL lowering, cardiovascular event continue to occur, and considerable effort is now directed at identifying and treating the residual risk that remains once lipid targets are met.Inflammation has long been implicated in the prognosis of patients with AMI.The inflammatory hypothesis of atherosclerosis moved from association to causation with the CANTOS trial, in which canakinumab-an interleukin (IL)-1β antagonist that lowers IL-6 and C-reactive protein (CRP) without altering lipids-reduced cardiovascular events.3) Low-dose colchicine subsequently reduced ischemic events after myocardial infarction (MI) and in chronic coronary disease, 4)5) whereas methotrexate, which does not lower IL-6 or CRP, was neutral (CIRT)-underscoring that benefit tracks specifically with the IL-6-CRP axis.6) More recently, however, the CLEAR-SYNERGY (OASIS-9) trial did not show a significant reduction in cardiovascular events with colchicine after MI, reminding us that the optimal agent, timing, and target population for anti-inflammatory therapy remain unsettled.7) In this context, the study by Hyun et al. 8) published in the current issue of the Korean Circulation Journal provides timely evidence on whether CRP adequately reflects residual risk after AMI.Among 661 such patients with serial high-sensitivity C-reactive protein (hsCRP) measurements, 19.5% had high residual inflammatory risk (RIR), defined as an hsCRP level >2 mg/L at 1 year.During a median follow-up of 5.3 years, high RIR was independently associated with a more than 4-fold higher risk of all-cause mortality (adjusted hazard ratio [HR], 3.41) and a 3-fold higher risk of major adverse cardiac and cerebrovascular event (adjusted HR, 3.08).Importantly, these associations remained consistent in the subgroup with LDL cholesterol <55 mg/dL.
Taken from the source record, never inferred. Follow any of these and new work involving them reaches your briefing.