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The Relationship between the Systemic Immune-Inflammation Index and Ischemia with Non-Obstructive Coronary Arteries
Muammer Karakayali1, Mehmet Altunova2, Turab Yakisan3
1Kafkas University School of Medicine, Department of Cardiology, Kars - Turquia.
Insights
The systemic immune-inflammation index (SII) is linked to ischemia with non-obstructive coronary artery (INOCA). Higher SII levels may indicate INOCA, offering a new predictive marker.
Area of Science:
- Cardiology
- Inflammation markers
- Coronary artery disease
Background:
- Ischemia with non-obstructive coronary artery (INOCA) involves coronary microvascular dysfunction or vasospasm, often seen in women.
- The systemic immune-inflammation index (SII), calculated as platelet × neutrophil/lymphocyte ratio, is a novel marker for adverse outcomes in coronary artery disease (CAD).
Purpose of the Study:
- To investigate the association between INOCA and the systemic immune-inflammation index (SII).
- To evaluate SII as a potential inflammatory marker for predicting INOCA.
Main Methods:
- A study included 424 patients: 212 with INOCA and 212 controls.
- Peripheral venous blood samples were collected before coronary angiography to measure SII and hematological parameters.
- Statistical significance was set at p<0.05.
Main Results:
- The optimal SII cut-off for INOCA prediction was 153.8, with 44.8% sensitivity and 78.77% specificity (AUC: 0.651).
- SII demonstrated a significantly higher predictive value for INOCA compared to lymphocyte, neutrophil, and platelet counts alone.
- The Area Under the Curve (AUC) for SII was 0.651, significantly outperforming individual components.
Conclusions:
- Elevated SII levels are independently associated with the presence of INOCA.
- SII can serve as an accessible indicator to supplement traditional, costly methods for INOCA prediction.
Background:
Ischemia with the non-obstructive coronary artery (INOCA) is an ischemic heart disease that mostly includes coronary microvascular dysfunction and/or epicardial coronary vasospasm due to underlying coronary vascular dysfunction and can be seen more commonly in female patients. The systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) is a new marker that predicts adverse clinical outcomes in coronary artery disease (CAD).
Objective:
This study aims to investigate the relationship between INOCA and SII, a new marker associated with inflammation.
Methods:
A total of 424 patients (212 patients with INOCA and 212 normal controls) were included in the study. Peripheral venous blood samples were received from the entire study population prior to coronary angiography to measure SII and other hematological parameters. In our study, the value of p<0.05' was considered statistically significant.
Results:
The optimal cut-off value of SII for predicting INOCA was 153.8 with a sensitivity of 44.8% and a specificity of 78.77% (Area under the curve [AUC]: 0.651 [95% CI: 0.603-0.696, p=0.0265]). Their ROC curves were compared to assess whether SII had an additional predictive value over components. The AUC value of SII was found to be significantly higher than that of lymphocyte (AUC: 0.607 [95% CI: 0.559-0.654, p = 0.0273]), neutrophil (AUC: 0.559 [95%CI: 0.511-0.607, p=0.028]) and platelet (AUC: 0.590 [95% CI: 0.541-0.637, p = 0.0276]) in INOCA patients.
Conclusions:
A high SII level was found to be independently associated with the existence of INOCA. The SII value can be used as an indicator to add to the traditional expensive methods commonly used in INOCA prediction.
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