CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 82 AFRICA Systemic immune–inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronary syndrome Fatma Özpamuk Karadeniz, Yusuf Karadeniz, Emine Altuntaş Abstract Objective: Inflammatory mechanisms play an important role in the pathogenesis of atherosclerosis and myocardial infarction. The clinical and prognostic importance of inflammatory parameters, such as neutrophil–lymphocyte (NLR) and platelet–lymphocyte ratios (PLR) in complete blood counts in acute myocardial infarction and other cardiovascular diseases has been demonstrated. However, systemic immune–inflammation index (SII) calculated from neutrophils, lymphocytes and platelets in the complete blood cell count has not been studied sufficiently and is thought to provide a better prediction. This study investigated whether haematological parameters such as SII, NLR and PLR were associated with clinical outcomes in acute coronary syndrome (ACS) patients. Methods: We included 1 103 patients who underwent coronary angiography for ACS between January 2017 and December 2021. The association between major adverse cardiac events (MACE) that developed in hospital and at 50 months of follow up and SII, NLR and PLR was compared. Long-term MACE were defined as mortality, re-infarction and targetvessel revascularisation. SII was calculated using the formula: NLR × total platelet count in the peripheral blood (per mm3). Results: Of the 1 103 patients, 403 were diagnosed with ST-elevation myocardial infarction and 700 with non-STelevation myocardial infarction. The patients were divided into a MACE and a non-MACE group. In hospital and during the 50-month follow up, 195 MACE were observed. SII, PLR and NLR were found to be statistically significantly higher in the MACE group (p < 0.001). SII, C-reactive protein level, age and white blood cell count were independent predictors of MACE in ACS patients. Conclusion: SII was found to be a strong independent predictor of poor outcomes in ACS patients. This predictive power was greater than that of PLR and NLR. Keywords: acute coronary syndrome, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune–inflammation index Submitted 8/3/22, accepted 27/2/23 Published online 5/5/23 Cardiovasc J Afr 2024; 35: 82–88 www.cvja.co.za DOI: 10.5830/CVJA-2023-011 Cardiovascular diseases, mostly acute myocardial infarction, are still the most common cause of mortality and morbidity worldwide and lead to 17.9 million deaths, according to World Health Organisation data. Following acute myocardial infarction, rapid percutaneous coronary intervention (PCI) and revascularisation are the most effective treatments that affect the prognosis by limiting the infarct area and reducing the development of heart failure and other cardiovascular complications. Despite advances in PCI technology, increased experience and many risk-prediction models, major adverse cardiovascular events unfortunately still continue after acute myocardial infarction. Inflammation is the key point of the atherosclerosis mechanism.1 Many different factors play a role in the complex inflammatory response in acute myocardial infarction.2 Neutrophil levels increase first in the inflammatory response following acute myocardial infarction and peak within one to three days.3 Thereafter, monocyte and platelet levels increase due to increased adrenaline and glucocorticoid levels, and lymphocyte levels decrease. Many studies have shown the effect of increased inflammatory parameters such as neutrophil– lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio in blood counts in response to an excessive inflammatory response on the prognosis of acute myocardial infarction and other cardiovascular diseases in the short and long term.4-6 Systemic immune–inflammation index (SII), a novel inflammation-related index, is a comprehensive combination based on peripheral lymphocyte, neutrophil and platelet counts. Although cardiovascular endpoints with NLR and PLR have been shown in some studies, their relationship with SII has not been shown sufficiently. It has however been shown that this index strongly predicts prognosis in malignancies,7,8 and it has recently been studied in cardiovascular diseases.9 In this study, we planned to compare the effect of a new inflammatory marker, the SII, and the more well-known parameters, NLR and PLR on mortality, re-infarction and target-vessel revascularisation in patients with acute coronary syndrome (ACS). Cardiology Department, Karamanoğlu Mehmetbey University, Karaman Research and Training Hospital, Karaman, Turkey Fatma Özpamuk Karadeniz, MD, kdrfatmakaradeniz@gmail.com Division of Endocrinology, Department of Internal Medicine, Karaman Research and Training Hospital, Karaman, Turkey Yusuf Karadeniz, MD Department of Cardiology, Sancaktepe Professor Dr İlhan Varank Training and Research Hospital, Istanbul, Turkey Emine Altuntaş, MD
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