Association Between Systemic Immune- Inflammation Index and Severity of Coronary Artery Disease in Acute Myocardial Infarction Patients

Bangladesh Heart Journal Pub Date : 2023-12-12 DOI:10.3329/bhj.v38i2.70263

Tania Easmin, Md Khalequzzaman, Md Mohsin Ahmed, M. Hasan

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Abstract

Background: Acute myocardial infarction is one of the leading causes of death across the world. Determination of severity is important in patients with acute myocardial infraction for the therapeutic decision making. Systemic immune-inflammation index (SII) has been proposed as a new prognostic marker in patients with acute MI. Several international studies have found to compare the relation between SII and severity of coronary artery disease. In these studies, they demonstrated that the SII is higher in severe CAD. In our country, no such study has been done yet to predict the severity of coronary artery disease by estimating SII in acute MI patients. Moreover, SII is cheap, easily available, non-invasive and routinely done procedure. Objectives: This study was conducted to find out the association of SII to severity of CAD in acute MI patients. Methods: This observational cross sectional analytical study was carried out in the Department of Cardiology, Dhaka Medical College Hospital, SSMC and Mitford Hospital and NICVD, Dhaka from March 2021 to February 2022. Patients with acute MI (STEMI and NSTEMI) were approached for this study according to inclusion and exclusion criteria. Coronary angiogram was done during index hospitalization. The severity of coronary artery disease was assessed by Vessel score and Gensini score. According to Gensini score CAD severity detected as mild to moderate (≤50) , severe (>50). Patients were divided into two groups according to Gensini score: Group A, severe CAD ( Gensini score >50) and Group B, mild to moderate CAD( Gensini score ≤50). SII calculated from admission CBC report. Results: Among 70 patients in our study 33 (47.1%) were in the high Gensini group (Group A) and 37 (52.85%) were in low Gensini group (Group B). Mean systemic immune inflammation index was found significantly higher in group A than group B, p value 0.001. We found strong positive correlation between SII and Gensini score (r= 0.7, p= 0.001). With the increase of SII, Gensini score increases demonstrating more severe CAD. In multivariate logistic regression analysis, after adjustment of confounding, hypertension (p=0.01, OR=4.84), NLR (P=0.004, OR=1.81) and SII (P=0.011. OR=1.002) remain independent predictor of severe CAD. In ROC curve analysis, the AUC of SII for predicting severity of CAD is 0.8 with p value < 0.001, 95% CI (0.71-0.91) and SII cut off value 686 can predict severe CAD with 78% sensitivity and 76% specificity. So, from this study, it is evident that SII is directly associated with coronary artery disease severity. Conclusion: Increased SII was associated with angiographically severe coronary artery disease in acute Myocardial Infarction patients and this association is independent of conventional cardiovascular risk factors. Bangladesh Heart Journal 2023; 38(2): 102-109

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急性心肌梗死患者全身免疫炎症指数与冠状动脉疾病严重程度的关系

背景：急性心肌梗死是导致全球死亡的主要原因之一。确定急性心肌梗死患者的严重程度对治疗决策非常重要。有人提出，全身免疫炎症指数（SII）是急性心肌梗死患者预后的新指标。一些国际研究发现了 SII 与冠状动脉疾病严重程度之间的关系。这些研究表明，严重的冠状动脉疾病患者的 SII 值较高。在我国，尚未有研究通过估计急性心肌梗死患者的 SII 来预测冠状动脉疾病的严重程度。此外，SII 是一种廉价、易得、无创和常规的程序：本研究旨在找出 SII 与急性心肌梗死患者冠状动脉疾病严重程度的关系：这项观察性横断面分析研究于 2021 年 3 月至 2022 年 2 月在达卡医学院附属医院、SSMC 和 Mitford 医院及达卡 NICVD 的心脏病科进行。根据纳入和排除标准，本研究选择了急性心肌梗死（STEMI 和 NSTEMI）患者。在住院期间进行冠状动脉造影。冠状动脉疾病的严重程度通过血管评分和 Gensini 评分进行评估。根据 Gensini 评分，CAD 的严重程度分为轻度至中度（≤50）和重度（>50）。根据 Gensini 评分将患者分为两组：A 组为重度 CAD（Gensini 评分 >50），B 组为轻中度 CAD（Gensini 评分 ≤50）。SII 根据入院时的 CBC 报告计算：70名患者中，33人（47.1%）属于高Gensini组（A组），37人（52.85%）属于低Gensini组（B组）。发现 A 组的平均全身免疫炎症指数明显高于 B 组，P 值为 0.001。我们发现 SII 与 Gensini 评分之间存在很强的正相关性（r= 0.7，p= 0.001）。随着 SII 的升高，Gensini 评分也随之升高，这表明 CAD 越来越严重。在多变量逻辑回归分析中，调整混杂因素后，高血压（P=0.01，OR=4.84）、NLR（P=0.004，OR=1.81）和 SII（P=0.011，OR=1.002）仍是严重 CAD 的独立预测因子。在 ROC 曲线分析中，SII 预测 CAD 严重程度的 AUC 为 0.8，P 值 <0.001，95% CI (0.71-0.91)，SII 切点值 686 可以预测严重 CAD，敏感性为 78%，特异性为 76%。因此，这项研究表明，SII 与冠状动脉疾病的严重程度直接相关：孟加拉心脏杂志》，2023 年；38（2）：102-109

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Bangladesh Heart Journal

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