A novel predictor in patients with coronary chronic total occlusion: systemic immune-inflammation index: a single-center cross-sectional study

Demir, Muhammed; Özbek, Mehmet

doi:10.1590/1806-9282.20211097

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Revista da Associação Médica Brasileira

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Sumário

Original Article • Rev. Assoc. Med. Bras. 68 (5) • May 2022 • https://doi.org/10.1590/1806-9282.20211097 copy

A novel predictor in patients with coronary chronic total occlusion: systemic immune-inflammation index: a single-center cross-sectional study

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

Severe inflammation is reportedly associated with subsequent cardiovascular events, including in patients with coronary artery disease. This study aimed to examine the prognostic value of systemic immune-inflammation index and determine mortality and clinical outcomes in patients with chronic coronary total occlusion.

METHODS:

Our study evaluated 366 consecutive coronary total occlusion patients. The clinical end points were all-cause mortality and major adverse cardiovascular events, which include target vessel revascularization, myocardial infarction, and cerebrovascular events during 105 months follow-up.

RESULTS:

The study findings showed 59 (16.1%) all-cause death, 22 (6%) target vessel revascularization cases, 32 (8.7%) myocardial infarction cases, and 13 (3.6%) cerebrovascular events cases, with a median follow-up of 49 months (26–74). Multivariate logistic regression analysis showed that systemic immune-inflammation index was not associated with target vessel revascularization, myocardial infarction, and cerebrovascular events. Multivariate Cox regression analysis found systemic immune-inflammation index to be associated with all-cause death. Kaplan-Meier analysis showed a lower survival rate and myocardial infarction-free survival time in patients with higher systemic immune-inflammation index scores.

CONCLUSION:

Although systemic immune-inflammation index is a preferable tool for the detection of mortality, it failed to give adverse outcomes. Larger multicenter studies are thus warranted to investigate the effect of systemic immune-inflammation index on clinical outcomes.

KEYWORDS:
Inflammation; Inflammation mediators; Coronary artery disease; Prognosis; Atherosclerosis

	Total (N=366)	Tertile 1 (N=122)	Tertile 2 (N=122)	Tertile 3 (N=122)	p
Age	62.26±11.09	60.46±10.57	62.39±10.49	63.94±11.95	0.049
Male	254 (69.4%)	89 (73%)	89 (73%)	76 (62.3%)	0.114
Hypertension	131 (35.8%)	37 (30.3%)	41 (33.6%)	53 (43.4%)	0.084
Diabetes mellitus	111 (30.3%)	36 (29.5%)	25 (20.5%)	50 (41%)	0.002
All-cause death	59 (16.1%)	10 (8.2%)	22 (18%)	27 (22.1%)	0.01
Myocardial infarction	32 (8.7%)	10 (8.2%)	6 (4.9%)	16 (13.1%)	0.074
Target vessel revascularization	22 (6%)	8 (6.6%)	6 (4.9%)	8 (6.6%)	0.824
Cerebrovascular event	13 (3.6%)	2 (1.6%)	4 (3.3%)	7 (5.7%)	0.22
Follow-up period (months)	49 (26–74)	46 (26–80)	55.5 (29.75–75)	40 (19–67.2)	0.02
Laboratory findings of the patients
White blood cell count (×10³ μL)	9.58±2.55	8.27±2.28	8.44±1.91	10.45±2.81	<0.001
Hemoglobin (g/dl)	13.74±1.89	14.1±1.74	13.95±1.82	13.17±1.98	<0.001
Platelets (×10³ μL)	257.77±84.64	218.31±66.45	251.19±61.15	303.81±98.52	<0.001
Lymphocytes (×10³ μL)	2.3±0.87	2.84±0.97	2.17±0.63	1.9±0.7	<0.001
Neutrophils (×10³ μL)	5.83±2.28	4.39±1.29	5.39±1.34	7.7±2.54	<0.001
GFR (mL/min/1.73m²)	85.24±24.61	87.45±24.18	87.13±22.92	81.15±26.29	0.079
Glucose (mg/dl)	143.85±85.24	141.14±75.57	135.09±62.7	155.33±82.19	0.091
Creatine (mg/dl)	1.02±0.72	0.96±0.55	1.01±0.77	1.08±0.82	0.4
Serum albumin (g/dl)	3.64±0.46	3.75±0.42	3.65±0.41	3.51±0.5	<0.001
SII (P*N/L)	758±599	340.84±84.65	620.19±86.44	1314±748.94	<0.001
Multivariable logistic regression analysis according to the clinical outcomes ^# # Ln SII or Ln WBC adjusted with age, sex, hypertension, diabetes mellitus, dyslipidemia, chronic renal failure, and smoking in multivariable logistic regression analysis.
	Ln SII adjusted		Ln WBC adjusted
Outcome n	OR (95%CI)	p	OR (95%CI)	p
TVR 22	0.96 (0.19–4.86)	0.963	0.8(0.16–4.02)	0.790
MI 32	2.52 (0.63–10)	0.192	2.34 (0.59–9.28)	0.226
CVE 13	6.41 (0.78–52)	0.082	2.21 (0.26–18.2)	0.461
Cox proportional hazard regression analysis of all-cause death regression models during 105 months of follow-up in the study population
	Univariate		Multivariate
	OR (95%CI)	p	OR (95%CI)	p
Age	1.065 (1.040–1.091)	<0.001	1.051 (1.025–1.077)	<0.001
Sex	1.24 (0.727–2.113)	0.430
Hypertension	1.66 (0.996–2.767)	0.052	1.075 (0.624–1.850)	0.795
Diabetes mellitus	1.170 (0.682–2.007)	0.568
Dyslipidemia	0.955 (0.346–2.637)	0.930
Chronic kidney disease	3.265 (1.603–6.647)	0.001	1.340 (0.594–3.026)	0.481
Smoker	0.681 (0.361–1.284)	0.235
Albumin	0.252 (0.153–0.415)	<0.001	0.418 (0.230–0.761)	0.004
Ln SII	5.842 (2.242–15.225)	<0.001	2.822 (1.028–7.748)	0.044

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[1] *Corresponding author: drmdemirr@gmail.com