The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, No. 548 Binwen Road, Binjiang District, Hangzhou, Zhejiang Province 310053, China.
Cardiac Ultrasound Center, Second Affiliated Hospital, Zhejiang University School of Medicine, No. 88 Jiefang Road, Shangcheng District, Hangzhou, Zhejiang Province 310000, China.
Int Immunopharmacol. 2024 Nov 15;141:112860. doi: 10.1016/j.intimp.2024.112860. Epub 2024 Aug 13.
In this study, the relationship between C-reactive protein-albumin-lymphocyte (CALLY) index, a novel composite indicator based on inflammation and nutrition, and major adverse cardiovascular events (MACEs) was investigated in patients with ST-segment elevation myocardial infarction (STEMI).
This retrospective study included 438 patients with STEMI who were treated at a single center between January 2017 and December 2020. The CALLY index was calculated for each patient on admission. The predictive value of the CALLY index for short- and long-term MACEs was evaluated using the area under the curve (AUC) analysis, and the corresponding AUC values were calculated. Clinical characteristics were analyzed after categorizing the population based on the optimal cut-off value of the CALLY index. Multivariate Cox regression analysis was used to determine factors independently associated with MACEs, while logistic regression analysis was used to identify factors independently associated with the severity of coronary artery lesions. Kaplan-Meier estimation and log-rank test were used to assess event-free survival rates among different CALLY index groups. Additionally, Spearman's correlation test was used to determine the association between the CALLY index and the Gensini score.
The AUC for predicting short-term MACEs in STEMI patients using the CALLY index was 0.758, while the AUC for predicting long-term MACEs was 0.740. Similarly, the AUC values were 0.815 and 0.819, respectively, when evaluating the short- and long-term mortality rates using the CALLY index. Multivariable Cox regression analysis revealed that a high CALLY index (threshold of 1.50) independently reduced the risk of short-term MACEs in patients with STEMI (hazard ratio [HR] = 0.274, 95 % confidence interval [CI] = 0.121-0.621, P=0.002). Multivariable Cox regression also demonstrated that a high CALLY index (threshold > 0.91) independently reduced the occurrence of long-term MACEs during follow-up in STEMI patients (HR=0.439, 95 % CI=0.292-0.659, P<0.001). Furthermore, multivariate logistic regression analysis revealed that a high CALLY index (threshold > 1.13) independently reduced the risk of severe coronary artery lesions in patients with STEMI (odds ratio = 0.299 [95 % CI=184-0.485], P<0.001). A positive correlation was observed between the CALLY index and the Gensini score (P<0.001).
The CALLY index is a novel, convenient, and valuable prognostic indicator exhibiting a protective effect against both short- and long-term MACEs in patients with STEMI, emphasizing the significance of inflammation/nutrition in this patient population.
本研究旨在探讨基于炎症和营养的新型复合指标 C-反应蛋白-白蛋白-淋巴细胞（CALLY）指数与 ST 段抬高型心肌梗死（STEMI）患者主要不良心血管事件（MACE）之间的关系。
本回顾性研究纳入了 2017 年 1 月至 2020 年 12 月期间在一家中心接受治疗的 438 例 STEMI 患者。入院时计算每位患者的 CALLY 指数。采用曲线下面积（AUC）分析评估 CALLY 指数对短期和长期 MACE 的预测价值，并计算相应的 AUC 值。根据 CALLY 指数的最佳截断值对人群进行分类后，分析临床特征。采用多变量 Cox 回归分析确定与 MACE 相关的独立因素，采用 logistic 回归分析确定与冠状动脉病变严重程度相关的独立因素。Kaplan-Meier 估计和对数秩检验用于评估不同 CALLY 指数组的无事件生存率。此外，采用 Spearman 相关检验确定 CALLY 指数与 Gensini 评分之间的相关性。
使用 CALLY 指数预测 STEMI 患者短期 MACE 的 AUC 为 0.758，预测长期 MACE 的 AUC 为 0.740。同样，使用 CALLY 指数评估短期和长期死亡率时，AUC 值分别为 0.815 和 0.819。多变量 Cox 回归分析显示，高 CALLY 指数（截断值为 1.50）可独立降低 STEMI 患者短期 MACE 的风险（风险比 [HR] = 0.274，95%置信区间 [CI] = 0.121-0.621，P = 0.002）。多变量 Cox 回归还表明，高 CALLY 指数（截断值>0.91）可独立降低 STEMI 患者随访期间长期 MACE 的发生风险（HR = 0.439，95%CI = 0.292-0.659，P<0.001）。此外，多元逻辑回归分析显示，高 CALLY 指数（截断值>1.13）可独立降低 STEMI 患者严重冠状动脉病变的风险（比值比=0.299[95%CI=184-0.485]，P<0.001）。CALLY 指数与 Gensini 评分呈正相关（P<0.001）。
CALLY 指数是一种新的、方便的、有价值的预后指标，对 STEMI 患者的短期和长期 MACE 均具有保护作用，强调了炎症/营养在该患者群体中的重要性。
