Association of Pan-Immune-Inflammation Value with All-Cause and Cardiovascular Mortality in Survivors of Myocardial Infarction: NHANES 2001-2018 Analysis.

Abstract

Background: Inflammatory responses critically impact long-term outcomes in myocardial infarction (MI) survivors, yet few biomarkers comprehensively evaluate systemic immune-inflammatory status. This study assessed the prognostic utility of a novel marker-the pan-immune-inflammation value (PIV)-for predicting all-cause and cardiovascular mortality post-MI.

Methods: Using the National Health and Nutrition Examination Survey data (2001-2018), 1559 MI survivors were included. PIV was calculated as (neutrophils × platelets × monocytes)/lymphocytes. Weighted Cox models assessed the association between log-transformed PIV (LnPIV) and mortality. Restricted cubic spline (RCS) models explored non-linear dose-response relationships, and predictive performance was evaluated via time-dependent ROC analysis.

Results: Over a median 75-month follow-up, 675 deaths occurred. LnPIV showed significant non-linear associations with all-cause (p < 0.0001) and cardiovascular mortality (p = 0.0471). When LnPIV ≥ 5.59, each unit increase was associated with an 85% (HR = 1.85, 95% CI: 1.49-2.28) higher all-cause mortality risk; for cardiovascular mortality, the risk increased by 77% (HR = 1.77, 95% CI: 1.20-2.63) when LnPIV ≥ 5.68. Time-dependent ROC analysis confirmed strong prediction above these thresholds.

Conclusion: PIV demonstrates threshold-dependent mortality risk stratification in MI patients, particularly effective in high-inflammatory subgroups, offering a potential tool for personalized risk stratification.