The Systemic Inflammation Index Predicts Poor Clinical Prognosis in Patients with Initially Diagnosed Acute Coronary Syndrome Undergoing Primary Coronary Angiography

Yi Gao,1,&ast; Yuqing Li,1,&ast; Xiaolin Chen,1,&ast; Chen Wu,2 Ziqiang Guo,1 Geng Bai,1 Tong Liu,1 Guangping Li1 1Tianjin Key Laboratory of Logic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, the Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China; 2Department of Emergency Medicine, The Second Hospital of Tianjin Medical University, Tianjin, 300211, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Guangping Li; Tong Liu, Tel +86-022-88328648, Fax +86-022-28261158, Email tic_tjcardiol@126.com; liutong@tmu.edu.cnBackground: Systemic inflammation index (SII: neutrophil count &ast; platelet count/lymphocyte count) is a new inflammatory marker that can reflect the degree of systemic inflammatory response after coronary artery disease (CAD). However, the predictive value of the SII for clinical prognosis in patients with initially diagnosed acute coronary syndrome (ACS) has yet to be thoroughly studied.Patients and Methods: Patients with initially diagnosed ACS who underwent primary coronary angiography in our hospital from January 2019 to April 2021 were included in this study. 757 patients with ACS who underwent primary coronary angiography were enrolled. According to the baseline SII level, the patients were divided into a high SII group and a low SII group. The primary endpoint was major cardiovascular events (MACEs), defined as cardiac death, non-fatal myocardial infarction (MI), and non-fatal stroke.Results: At a median follow-up of 33.9 months, 140 (18.5%) MACEs were recorded. Receiver operating characteristic (ROC) curve analysis showed that SII’s best cut-off value for predicting MACEs was 713.9&ast;109/L. Kaplan-Meier survival curve analysis showed that the survival rate of the low SII group was higher than the high SII group (P< 0.001). Compared with the low SII group, the risk of MACEs was significantly increased in the high SII group (89 cases (33.3%) vs.51 patients (10.4%), P< 0.001). Univariate and multivariate Cox regression analysis manifested that high SII level was independently associated with the occurrence of MACEs in patients with ACS undergoing primary coronary angiography (adjusted hazard ratio [HR]: 2.915, 95% confidence interval (CI%): 1.830– 4.641, P< 0.001). Adding SII to the conventional risk factor model improved the predictive value of MACEs.Conclusion: This study showed that elevated SII was associated with adverse cardiovascular prognosis in patients with ACS undergoing primary coronary angiography, making SII a valuable predictor of poor prognosis in patients with ACS undergoing primary coronary angiography.Keywords: systemic inflammation index, immune response, coronary angiography, acute coronary syndrome, clinical prognosis