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Published on: January 28, 2020
Systemic Immune-Inflammation Index Predicts Long-Term Outcomes in Patients with Three-Vessel Coronary Disease After
Ji Zhao1, Haichen Lv1, Da Yin1
1Department of Cardiology, the First Affiliated Hospital of Dalian Medical University, Dalian City, People's Republic of China.
Insights
High systemic immune inflammation index (SII) predicts worse long-term outcomes in three-vessel disease (TVD) patients post-revascularization. SII improves cardiac event prediction beyond traditional risk factors, aiding in better patient management.
Area of Science:
- Cardiology
- Immunology
- Oncology
Background:
- Three-vessel disease (TVD) is a complex coronary artery disease requiring revascularization.
- Prognostic markers are crucial for managing long-term outcomes in TVD patients.
- The systemic immune-inflammation index (SII) reflects systemic inflammation and immune status.
Purpose of the Study:
- To investigate the prognostic value of SII in patients with TVD after revascularization.
- To assess SII's ability to predict major adverse and cerebrovascular events (MACCE) and all-cause death.
- To determine if SII improves risk prediction accuracy compared to traditional factors.
Main Methods:
- A cohort of 3561 TVD patients undergoing revascularization (2013-2018) was analyzed.
- Patients were stratified into low SII (<694.3 × 10^9/L) and high SII (≥694.3 × 10^9/L) groups.
- Cox regression, C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used.
Main Results:
- High SII was independently associated with increased risk of MACCE (HR 1.65) and all-cause death (HR 2.96) after a 2.4-year follow-up.
- Adding SII to a baseline model significantly improved prediction accuracy for MACCE (NRI 0.115) and all-cause death (NRI 0.369).
- SII addition demonstrated significant IDI for both MACCE (0.0022) and all-cause death (0.0033).
Conclusions:
- Elevated SII is an independent predictor of adverse long-term outcomes in TVD patients post-revascularization.
- SII enhances the prognostic capability for MACCE and mortality beyond traditional risk factors.
- SII offers improved risk stratification for TVD patients undergoing revascularization.
Objective:
This study aimed to investigate the prognostic value of systemic immune inflammation index (SII) concerning long-term outcomes in patients with the three-vessel disease (TVD) after revascularization in a large cohort.
Methods:
In total, 3561 TVD patients who had undergone revascularization between 2013 and 2018 were included in the study. Patients were divided into the low SII (<694.3 × 109/L) (n = 2556, 71.8%) and the high SII (≥694.3 × 109/L) group (n = 1005, 28.2%). The C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were calculated to assess whether the addition of SII to a baseline model with traditional risk factors improved the accuracy of cardiac event prediction. The primary outcome was the frequency of major adverse and cerebrovascular events (MACCE). The secondary outcome was the incidence of all-cause death.
Results:
After 2.4 years of follow-up, the Cox proportional hazard regression model analysis displayed that high SII was independently associated with an increased risk of developing future MACCE (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.23-2.21, p = 0.001) and all-cause death (HR: 2.96; 95% CI: 1.19-7.32, p = 0.019). The addition of SII significantly improved the reclassification beyond the baseline model with traditional risk factors (MACCE: NRI, 0.115; p = 0.0001; all-cause death: NRI, 0.369; p = 0.0001). Reclassification with the addition of SII also demonstrated an IDI of 0.0022 (p = 0.006) in MACCE and 0.0033 (p = 0.014) in all-cause death.
Conclusion:
In TVD patients after revascularization, increased SII is an independent prognostic factor for long-term outcomes of MACCE and death. Compared to traditional risk factors, SII improved the risk prediction of major cardiovascular events in TVD patients who underwent revascularization.
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