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A Nomogram Based on the Castelli Risk Index for Predicting Prognosis in Patients With Acute Coronary Syndrome

Yan Liu1, Ge Song1, Ying Zhang1,2,3

  • 1Department of Cardiology, The Affiliated Hospital of Chengde Medical University, Chengde, China.

Immunity, Inflammation and Disease
|April 8, 2026
PubMed

Insights

Castelli's risk indices (CRI-I and CRI-II) predict major adverse cardiovascular events (MACEs) in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). Higher CRI values indicate increased risk, aiding in prognosis assessment.

Area of Science:

  • Cardiology
  • Clinical Lipidology
  • Interventional Cardiology

Background:

  • Composite lipid indices are linked to disease risk and prognosis.
  • No prior studies investigated Castelli's risk indices (CRI-I, CRI-II) in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI).

Purpose of the Study:

  • To evaluate the prognostic value of CRI-I and CRI-II in patients with ACS undergoing PCI.
  • To determine the association between CRI-I, CRI-II, and major adverse cardiovascular events (MACEs).

Main Methods:

  • Prospective cohort study of 1475 ACS patients undergoing PCI (January 2016 - December 2018).
  • Measurement of CRI-I and CRI-II.
  • Follow-up for MACEs (all-cause mortality, heart failure rehospitalization, myocardial infarction recurrence, in-stent restenosis, repeat PCI) at regular intervals.

Main Results:

  • Multivariable Cox regression showed increased MACE risk with higher CRI-I and CRI-II.
  • Significantly lower cumulative survival rates for patients with CRI-I ≥ 3.350 and CRI-II ≥ 1.697 (log-rank tests, p < 0.001).
  • A nomogram demonstrated good predictive performance for 1-, 2-, and 3-year survival probabilities.

Conclusions:

  • Elevated CRI-I (≥ 3.350) and CRI-II (≥ 1.697) are independent predictors of MACEs.
  • These indices can aid in risk stratification for ACS patients undergoing PCI.
Abstract

Keywords:
composite lipid indicesdyslipidemia, high‐density lipoprotein cholesterollow‐density lipoprotein cholesterolmajor adverse cardiovascular events

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