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Endothelial Activation and Stress Index (EASIX) as a Predictor of No-Reflow in Patients Undergoing Saphenous Vein
Emirhan Hancıoğlu1, Sevgi Özcan2, Emre Melik Faideci3
1Department of Cardiology, Acıbadem District Hospital, Istanbul Medipol University, Istanbul, Kadıkoy, Turkey.
Insights
The Endothelial Activation and Stress Index (EASIX) is linked to no-reflow phenomenon (NRP) after saphenous vein graft percutaneous coronary intervention (PCI). This simple score can help predict NRP risk in patients undergoing SVG PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Biomarkers
Background:
- No-reflow phenomenon (NRP) is a major complication following percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs).
- The Endothelial Activation and Stress Index (EASIX) is a novel marker reflecting endothelial dysfunction and inflammation, calculated from LDH, creatinine, and platelet count.
Purpose of the Study:
- To investigate the association between the EASIX score and the occurrence of NRP in patients undergoing SVG PCI.
- To evaluate EASIX as a potential predictor of NRP in this patient population.
Main Methods:
- A retrospective analysis of 343 patients with non-ST elevation myocardial infarction undergoing SVG PCI.
- Patients were grouped based on the development of NRP; multivariate logistic regression and ROC curve analysis were used to identify predictors and assess EASIX performance.
Main Results:
- NRP was observed in 20.7% of patients.
- Higher EASIX scores were significantly associated with NRP (p < 0.001), alongside elevated neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII).
- EASIX emerged as an independent predictor of NRP (OR: 3.151, p=0.001) with an AUC of 0.779.
Conclusions:
- The EASIX score is independently associated with no-reflow phenomenon in patients undergoing SVG PCI.
- EASIX presents a simple, calculable tool for predicting NRP risk in this clinical setting.
Background:
No-reflow phenomenon (NRP) is a significant complication of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). The Endothelial Activation and Stress Index (EASIX), derived from LDH, creatinine, and platelet count, is a marker of endothelial dysfunction and inflammation.
Aims:
To assess the association between EASIX and NRP in patients undergoing SVG PCI.
Methods:
A total of 343 patients with non-ST elevation myocardial infarction who underwent SVG PCI between March 2020 and June 2025 were retrospectively enrolled. Patients were categorized according to the development of NRP. Multivariate logistic regression identified independent predictors, and the discriminative performance of EASIX was assessed using receiver operating characteristic (ROC) curves.
Results:
NRP occurred in 71 patients (20.7%). Patients with NRP had higher EASIX scores (1.61 ± 1.43 vs. 0.73 ± 0.36, p < 0.001), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). EASIX (OR: 3.151, p = 0.001), NLR, and reduced left ventricular ejection fraction were independent predictors of NRP. ROC analysis indicated that EASIX predicted NRP with an AUC of 0.779 (95% CI: 0.711-0.847, p < 0.001). The optimal EASIX cut-off was 0.79, with 70% sensitivity and 68% specificity.
Conclusion:
EASIX, a simple and easily calculated score, is independently associated with no-reflow in patients undergoing SVG PCI.
