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The CALLY index as a novel predictor of left ventricular aneurysm in patients with ST-segment elevation myocardial
Qinshuo Zhao1, Mengqing Li2, Dong Hu3
1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, China.
Insights
A lower C-reactive protein-albumin-lymphocyte index (CALLY) is linked to increased left ventricular aneurysm (LVA) risk in ST-elevation myocardial infarction (STEMI) patients. The CALLY index aids in predicting LVA and improving patient risk stratification.
Area of Science:
- Cardiology
- Biomarkers
- Myocardial Infarction
Background:
- Left ventricular aneurysm (LVA) is a severe complication of ST-segment elevation myocardial infarction (STEMI).
- The C-reactive protein-albumin-lymphocyte index (CALLY) is a novel inflammatory biomarker.
- The predictive value of CALLY for LVA development is not well understood.
Purpose of the Study:
- To investigate the association between the CALLY index and the risk of LVA in STEMI patients.
- To evaluate the predictive performance of a nomogram incorporating CALLY for LVA risk stratification.
Main Methods:
- Retrospective analysis of 1,507 STEMI patients treated with primary percutaneous coronary intervention (pPCI).
- Patients categorized into quartiles based on CALLY levels; dose-response relationship explored using restricted cubic splines.
- Multivariable logistic regression and LASSO regression identified independent predictors; nomogram developed and validated.
Main Results:
- LVA occurred in 10.42% of patients; incidence decreased with higher CALLY quartiles (P < 0.001).
- A nonlinear inverse association was found between CALLY and LVA risk.
- Lower CALLY, higher Killip class, IRA-LAD, lower LVEF, and elevated cTnI were independent LVA predictors. Nomogram showed good discrimination (AUC=0.931).
Conclusions:
- A lower CALLY index at admission is an independent predictor of higher LVA risk in STEMI patients post-pPCI.
- The CALLY-based nomogram provides reliable risk stratification for LVA, potentially aiding early clinical decisions.
Background:
Left ventricular aneurysm (LVA) is a serious mechanical complication following ST-segment elevation myocardial infarction (STEMI). The C-reactive protein-albumin-lymphocyte index (CALLY) is a novel composite inflammatory biomarker, but its predictive value for LVA remains unclear.
Methods:
We retrospectively enrolled 1,507 STEMI patients who underwent primary percutaneous coronary intervention (pPCI) between January 2020 and March 2026. Patients were divided into quartiles based on CALLY levels. Restricted cubic spline (RCS) analysis was used to explore the dose-response relationship. Least absolute shrinkage and selection operator (LASSO) regression was used for variable screening. Multivariable logistic regression was performed to identify independent predictors. A nomogram was built and validated using receiver operating characteristic (ROC) curves, bootstrap calibration curves, and decision curve analysis (DCA).
Results:
LVA occurred in 157 patients (10.42%). The incidence of LVA declined gradually with increasing CALLY quartiles (27.32%, 7.18%, 3.98%, 3.18%; P < 0.001). RCS verified a nonlinear inverse association between CALLY and LVA risk (P for nonlinearity<0.05). After adjustment, CALLY (Q4 vs. Q1: OR = 0.32, 95%CI: 0.15-0.69, P = 0.003), Killip class ≥2, infarct-related artery-left anterior descending (IRA-LAD), left ventricular ejection fraction (LVEF), and cardiac troponin I (cTnI) ≥ 50 ng/mL were independent predictors of LVA. The nomogram based on these five predictors showed good discrimination (AUC=0.931), acceptable calibration, and favorable clinical net benefit.
Conclusion:
A lower admission CALLY index was independently associated with a higher risk of LVA in STEMI patients treated with pPCI. The CALLY-based nomogram supports reliable risk stratification and may assist with early clinical decision-making.
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