CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 87 was examined together with NLR and PLR. In this study by Liu et al., NLR and PLR with SII provided a prognosis prediction in metastatic non-small-cell lung cancer treated with nivolumab.23 In addition to SII, we studied the PLR together with NLR, which are two other indicators of inflammatory status in patients with acute myocardial infarction. In the study conducted with 2 518 patients diagnosed with STEMI, increased NLR and PLR were found to be associated with short- and long-term mortality.5 In the meta-analysis including 10 245 patients, they revealed that the NLR is an indicator of hospitalisation and long-term prognosis in patients with STEMI undergoing PCI.24 In a meta-analysis of 12 619 patients by Dong et al., the increased PLR was an indicator of in-hospital and long-term mortality in STEMI patients who underwent PCI.25 The reason why we used NLR and PLR together with SII in our study was to provide a more accurate estimation of three parameters compared to two parameters and to compare this index with these two more well-known ratios. In the present study, SII provided better prediction than PLR and NLR. In our study results, apart from SII, CRP was also found to be an independent predictor for MACE. Many studies have already found that CRP is an independent predictor of mortality.26 In the study conducted in 5 145 ACS patients, a significant correlation was found between high-sensitivity CRP, measured at the start of the study and 16 weeks later, and MACE.27 WBC, another indicator of inflammation, was also discovered to be an independent predictor for MACE in our study. In a study conducted with 2 208 ACS patients, high baseline WBC levels were found to be associated with high six-month mortality rates.28 Since SII, CRP and WBC all show level of inflammation, we found increased levels to be an independent predictor for MACE in our study, which supports the literature. Our study found that SII, NLR and PLR could all be used to predict in-hospital and long-term MACE in ACS patients. Multivariate Cox regression models showed that all these markers were not independent predictors for MACE in ACS patients. Among these inflammatory markers, only SII was found to be an independent predictor for MACE. SII could therefore be an excellent clinical laboratory marker to identify high-risk ACS patients. There were some limitations to this study. Our study differed from other studies in that NLR, PLR and SII were examined together and the study was performed on both STEMI and NSTEMI patients. It was conducted in a single centre and with a moderate number of patients, so there might be selection bias. Furthermore, it was a retrospective, cross-sectional study. For this reason, prospective studies with a larger number of patients are needed. Conclusion Although many laboratory markers are used to predict the prognosis of ACS patients, SII seems to be very strong compared to other indicators. It could enter routine clinical use in patients with ACS and other cardiovascular diseases. References 1. Zhu Y, Xian X, Wang Z, Bi Y, Chen Q, Han X, et al. 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