Systemic inflammatory response index in the differentiation of unstable angina pectoris and non-ST elevation
Serdar Akyel1, Abdulkadir Yildiz
1Department of Cardiology, Kastamonu University School of Medicine, Kastamonu, Turkey.
Insights
The Systemic Inflammatory Response Index (SIRI) can help differentiate non-ST-elevation myocardial infarction (NSTEMI) from unstable angina pectoris (USAP) in acute chest pain patients. Higher SIRI levels at admission indicate a higher likelihood of NSTEMI.
Area of Science:
- Cardiology
- Clinical Chemistry
- Inflammation Biomarkers
Background:
- The Systemic Inflammatory Response Index (SIRI) is a marker of inflammation derived from complete blood count parameters.
- Differentiating non-ST-elevation myocardial infarction (NSTEMI) from unstable angina pectoris (USAP) is crucial for timely and appropriate patient management.
- Early identification of NSTEMI can lead to prompt reperfusion therapy and improved patient outcomes.
Purpose of the Study:
- To evaluate the utility of SIRI in distinguishing NSTEMI from USAP in patients presenting with acute chest pain.
- To assess whether SIRI can serve as an early predictor of myocardial infarction in the absence of initial troponin elevation.
Main Methods:
- A retrospective observational study included 151 patients with chest pain and initially negative high-sensitive troponin-I levels.
- Patients were categorized into NSTEMI (subsequent troponin elevation) or USAP (no troponin elevation) groups.
- Systemic Inflammatory Response Index (SIRI) was calculated at admission using neutrophil, monocyte, and lymphocyte counts.
Main Results:
- Admission SIRI values were significantly higher in the NSTEMI group compared to the USAP group (P < .001).
- Higher SIRI levels independently predicted troponin positivity (OR, 1.47; 95% CI, 1.17-1.84).
- Receiver operating characteristic analysis showed an area under the curve of 0.71, with a cutoff of 1.58 yielding 72% sensitivity and 69% specificity for predicting troponin positivity.
Conclusions:
- The Systemic Inflammatory Response Index (SIRI) is a valuable, readily available, and inexpensive tool for the early differentiation of NSTEMI from USAP.
- SIRI's ease of calculation makes it suitable for diverse healthcare settings, aiding in rapid clinical decision-making for acute chest pain.
- Utilizing SIRI can potentially improve the diagnostic accuracy and management of patients with acute coronary syndromes.
Abstract:
The systemic inflammatory response index (SIRI), calculated from routine complete blood count parameters, has emerged as a potential marker of inflammation and a predictor of prognosis in various cardiovascular conditions. This study aimed to evaluate the utility of SIRI in differentiating non-ST-elevation myocardial infarction (NSTEMI) from unstable angina pectoris (USAP) in patients presenting with acute chest pain. In this retrospective observational study, patients admitted to the emergency department with chest pain and subsequently diagnosed with USAP or NSTEMI were included. Only patients with negative high-sensitive troponin-I levels at the time of admission were enrolled in both groups. During follow-up, those who showed an increase in troponin levels were classified as NSTEMI, whereas patients without troponin elevation were classified as USAP. The SIRI was calculated using blood samples obtained at the time of admission to the emergency department by multiplying the neutrophil and monocyte counts and dividing by the lymphocyte count. Troponin positivity was used to distinguish NSTEMI from USAP. SIRI was assessed at admission in patients with chest pain and normal troponin. Higher SIRI levels in NSTEMI suggest its potential for early differentiation from USAP. Multivariate logistic regression analysis was performed to determine independent predictors of troponin positivity, and receiver operating characteristic curve analysis was used to assess diagnostic performance. A total of 151 patients were included in the analysis. Admission SIRI values were significantly higher in the troponin-positive (NSTEMI) group compared with the troponin-negative (USAP) group (P < .001). In multivariate analysis, higher admission SIRI levels independently predicted troponin positivity (odds ratio [OR], 1.47; 95% confidence interval [CI], 1.17-1.84; P < .001). Receiver operating characteristic analysis revealed an area under the curve of 0.71 (95% CI 0.63-0.79, P < .001). A cutoff value of 1.58 for SIRI demonstrated 72% sensitivity and 69% specificity in predicting troponin positivity. SIRI, a readily available, inexpensive, and rapidly obtainable index derived from standard complete blood count parameters, may serve as a valuable adjunctive tool for the early differentiation of NSTEMI from USAP in patients with acute chest pain. Its ease of calculation within minutes of admission makes it suitable in diverse healthcare settings.
More Related Videos
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:27Angina II: Classification
01:29Angina III: Clinical Manifestations and Assessment
01:27Myocarditis II: Clinical Features and Diagnostic Tests