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Systemic immune-inflammation index as a predictor of prognosis after carotid artery stenting compared with C-reactive
Shuji Morikawa1,2, Kenji Okumura3, Naoya Inoue1,2
1Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan.
Insights
The systemic immune-inflammation index (SII) predicts long-term outcomes in carotid artery stenting (CAS) patients. SII is a superior inflammatory marker for prognosis compared to C-reactive protein (CRP).
Area of Science:
- Cardiovascular Medicine
- Inflammation Research
- Medical Diagnostics
Background:
- Immune-inflammatory processes are integral to atherosclerosis progression.
- The systemic immune-inflammation index (SII) shows potential in predicting outcomes for stroke and ischemic heart disease patients.
- C-reactive protein (CRP) is a known inflammatory marker.
Purpose of the Study:
- To evaluate the predictive capability of SII for short- and long-term prognoses in patients undergoing carotid artery stenting (CAS).
- To compare the predictive performance of SII against CRP in CAS patients.
Main Methods:
- A single-center retrospective study involving 129 patients who underwent CAS.
- Patients were stratified into tertiles based on SII levels.
- Primary endpoint was major adverse cardiac and cerebrovascular events (MACCE); secondary endpoints included stroke incidence and all-cause death.
Main Results:
- Higher SII tertiles correlated with increased long-term MACCE and stroke rates.
- The highest SII tertile (>647) independently predicted long-term stroke (HR 21.3) and MACCE (HR 3.98).
- SII demonstrated superior predictive ability (AUC 0.72) for long-term MACCE compared to CRP (AUC 0.64).
Conclusions:
- SII is an independent predictor of long-term prognosis in patients following CAS.
- SII is suggested to be a more effective inflammatory prognostic marker than CRP in this patient cohort.
Background:
Immune-inflammatory processes are highly associated with the progression of atherosclerosis. The systemic immune-inflammation index (SII) is a potential predictor for clinical outcomes in patients with stroke and ischemic heart disease. Therefore, this study aimed to investigate whether SII can accurately predict the short- and long-term prognoses in patients who underwent carotid artery stenting (CAS) compared to that with C-reactive protein (CRP).
Methods:
This study was a single-center retrospective investigation. Overall, 129 patients who underwent CAS were categorized into tertiles based on their SII levels. We primarily investigated the long-term major adverse cardiac and cerebrovascular events (MACCE) and secondarily the in-hospital and long-term stroke incidence, as well as all-cause death.
Results:
The in-hospital stroke rate tended to increase with a rise in SII (P = 0.13). Over the 5-year follow-up period, the Kaplan-Meier overall incidence of MACCE was 9.3%, 16.3%, and 39.5% in the lowest to highest tertiles, respectively (log-rank trend test, P<0.001). The rates of stroke and MACCE during the long-term follow-up were significantly higher with increasing SII. Cox regression analysis showed that the highest tertile of SII (>647) was a predictor of the incidence of long-term stroke (hazard ratio (HR), 21.3; 95% confidence interval (CI), 2.41-188; P = 0.006) and MACCE (HR, 3.98; 95% CI, 1.80-8.81; P<0.001). However, after adjusting for both SII and CRP, only SII remained a significant independent predictor, whereas CRP became less relevant. The receiver operating characteristic curve analysis of long-term MACCE showed that the area under the curve (AUC) for SII (AUC, 0.72; 95% CI, 0.60-0.84; P<0.001) was greater than that of CRP (AUC, 0.64; 95% CI, 0.51-0.77; P = 0.040).
Conclusion:
SII was shown to be an independent predictor of long-term prognosis in patients who underwent CAS and was suggested to be superior to CRP as an inflammatory prognosis predictor.
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