{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T21:52:56Z","timestamp":1793137976606,"version":"4.5.0"},"reference-count":25,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:p>Despite major advances in lipid-lowering therapy and stent technology, a substantial proportion of patients undergoing contemporary percutaneous coronary intervention (PCI) experience recurrent major adverse cardiovascular events (MACE) driven by persistent residual inflammatory risk (RIR). This Perspective highlights that, once LDL\u2212C is optimized below 70 mg\/dL, RIR\u2014quantified by high\u2212sensitivity C\u2212reactive protein (hsCRP \u22652 mg\/L)\u2014emerges as the dominant modifiable driver of recurrent events. Landmark meta\u2212analyses and large registries demonstrate that persistent elevation of hsCRP at 1 month post\u2212PCI occurs in approximately 43% of patients and independently predicts 12\u2212month MACE (RR 1.64), all\u2212cause mortality (RR 3.25), and other adverse outcomes, outperforming residual cholesterol risk after multivariable adjustment. Mechanistically, the acute\u2212phase hsCRP surge induced by procedural injury resolves by 4\u20136 weeks, after which the 1\u2212month value reliably reflects ongoing NLRP3 inflammasome activation, IL\u22121\u03b2\/IL\u22126 signaling, and macrophage\u2212driven plaque inflammation rather than transient artefacts. Accordingly, we propose a new \u201cdual\u2212target\u201d definition of optimal secondary prevention: achievement of both LDL\u2212C &amp;lt;70 mg\/dL and hsCRP &amp;lt;2 mg\/L at the 1\u2212month landmark. This biomarker\u2212guided approach represents a hypothesis-generating framework to enable precision deployment of low\u2212dose colchicine or IL\u22126 pathway inhibitors (e.g., ziltivekimab) in patients with persistent RIR, directly addressing the enrichment gap observed in neutral broad anti\u2212inflammatory trials such as CLEAR\u2212SYNERGY. We therefore propose consideration of routine 1\u2212month hsCRP reassessment as a potential future Class IIa recommendation in ESC\/ACC guidelines. This strategy may transform silent residual inflammatory risk into a precisely treatable immunologic target, pending prospective validation in dedicated trials.<\/jats:p>","DOI":"10.3389\/fimmu.2026.1840386","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T04:19:17Z","timestamp":1777609157000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Persistent residual inflammatory risk at 1 month after contemporary PCI: rationale for routine hsCRP reassessment and dual-target therapy"],"prefix":"10.3389","volume":"17","author":[{"given":"Xinwang","family":"Gong","sequence":"first","affiliation":[{"name":"First Clinical Medical College, Yunnan University of Traditional Chinese Medicine","place":["Kunming, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Zhou","sequence":"additional","affiliation":[{"name":"Special Medical Department, Dazhou Central 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