Division of Cardiology, Department of Medicine, Healthcare and Management Center, Taipei, Taiwan.
Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.
Eur J Clin Invest. 2020 May;50(5):e13230. doi: 10.1111/eci.13230. Epub 2020 May 11.
This study examines the predictive value of a novel systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) in coronary artery disease (CAD) patients.
A total of 5602 CAD patients who had undergone a percutaneous coronary intervention (PCI) were enrolled. They were divided into two groups by baseline SII score (high SII vs low SII) to analyse the relationship between SII groups and the long-term outcome. The primary outcomes were major cardiovascular events (MACE) which includes nonfatal myocardial infarction (MI), nonfatal stroke and cardiac death. Secondary outcomes included a composite of MACE and hospitalization for congestive heart failure.
An optimal SII cut-off point of 694.3 × 10 was identified for MACE in the CAD training cohort (n = 373) and then verified in the second larger CAD cohort (n = 5602). Univariate and multivariate analyses showed that a higher SII score (≥694.3) was independently associated with increased risk of developing cardiac death (HR: 2.02; 95% CI: 1.43-2.86), nonfatal MI (HR: 1.42; 95% CI: 1.09-1.85), nonfatal stroke (HR: 1.96; 95% CI: 1.28-2.99), MACE (HR: 1.65; 95% CI: 1.36-2.01) and total major events (HR: 1.53; 95% CI: 1.32-1.77). In addition, the SII significantly improved risk stratification of MI, cardiac death, heart failure, MACE and total major events than conventional risk factors in CAD patients by the significant increase in the C-index (P < .001) and reclassification risk categories by significant NRI (P < .05) and IDI (P < .05).
SII had a better prediction of major cardiovascular events than traditional risk factors in CAD patients after coronary intervention.
本研究旨在探讨一种新型的全身免疫炎症指数（SII，血小板×中性粒细胞/淋巴细胞比值）在冠心病（CAD）患者中的预测价值。
共纳入 5602 例行经皮冠状动脉介入治疗（PCI）的 CAD 患者。根据基线 SII 评分（高 SII 与低 SII）将其分为两组，分析 SII 组与长期预后的关系。主要终点事件为主要心血管不良事件（MACE），包括非致死性心肌梗死（MI）、非致死性卒中和心源性死亡。次要终点事件包括 MACE 和充血性心力衰竭住院的复合终点。
在 CAD 训练队列（n=373）中，确定了 SII 最佳截断值为 694.3×10，用于预测 MACE，然后在第二个更大的 CAD 队列（n=5602）中进行了验证。单因素和多因素分析表明，较高的 SII 评分（≥694.3）与发生心源性死亡（HR：2.02；95%CI：1.43-2.86）、非致死性 MI（HR：1.42；95%CI：1.09-1.85）、非致死性卒中等风险增加独立相关（HR：1.96；95%CI：1.28-2.99）、MACE（HR：1.65；95%CI：1.36-2.01）和总主要事件（HR：1.53；95%CI：1.32-1.77）。此外，SII 较传统危险因素显著提高了 MI、心源性死亡、心力衰竭、MACE 和总主要事件的风险分层能力，C 指数（P<0.001）和重新分类风险类别显著增加了 NRI（P<0.05）和 IDI（P<0.05）。
SII 对冠状动脉介入治疗后 CAD 患者的主要心血管事件预测优于传统危险因素。
