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. 2023 Sep 28;26(11):108060.
doi: 10.1016/j.isci.2023.108060. eCollection 2023 Nov 17.

Prognostic significance of inflammation in patients with coronary artery disease at low residual inflammatory risk

Tianyu Li  1 , Peizhi Wang  1 , Xiaozeng Wang  2 , Zhenyu Liu  3 , Zheng Zhang  4 , Yongzhen Zhang  5 , Zhifang Wang  6 , Yingqing Feng  7 , Qingsheng Wang  8 , Xiaogang Guo  9 , Xiaofang Tang  10 , Jingjing Xu  10 , Ying Song  10 , Yan Chen  10 , Na Xu  10 , Yi Yao  10 , Ru Liu  10 , Pei Zhu  10 , Yaling Han  3 , Jinqing Yuan  1   10
Affiliations

Prognostic significance of inflammation in patients with coronary artery disease at low residual inflammatory risk

Tianyu Li et al. iScience. .

Abstract

Patients with coronary artery disease (CAD) at low residual inflammatory risk are often overlooked in research and practice. This study examined the associations between fourteen inflammatory indicators and all-cause mortality in 5,339 CAD patients with baseline high-sensitivity C-reactive protein (hsCRP) <2 mg/L who received percutaneous coronary intervention and statin and aspirin therapy. The median follow-up time was 2.1 years. Neutrophil-derived systemic inflammatory response index (SIRI) yielded the strongest and most robust association with all-cause mortality among all indicators. Lower hsCRP remained to be associated with a lower risk of all-cause mortality. A newly developed comprehensive inflammation score (CIS) showed better predictive performance than other indicators, which was validated by an independent external cohort. In conclusion, neutrophil-derived indicators, particularly SIRI, strongly predicted all-cause mortality independent of hsCRP in CAD patients at low residual inflammatory risk. CIS may help identify individuals with inflammation burdens that cannot be explained by hsCRP alone.

Keywords: Cardiovascular medicine; Death; Pathophysiology.

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Conflict of interest statement

The authors declare no competing interests.

Figures

None
Graphical abstract
Figure 1
Figure 1
Study flowchart by cohort Abbreviations: hsCRP, high-sensitivity C-reactive protein; PCI, percutaneous coronary intervention; PCI-2013, patients undergoing percutaneous coronary intervention in 2013 at Fuwai Hospital; PROMISE, the prospective observational multi-center cohort for ischemic and hemorrhage risk in coronary artery disease patients.
Figure 2
Figure 2
Spearman correlation between each pair of inflammation indicators Abbreviations: AISI, aggregate index of systemic inflammation; hsCRP, high-sensitivity C-reactive protein; MLR, monocyte-to-lymphocyte ratio; NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; PNI, prognostic nutritional index; SII, systemic inflammatory index; SIRI, systemic inflammatory response index; WBC, white blood cells.
Figure 3
Figure 3
Survival curves for patients stratified by levels of inflammation indicators (A–N) (A) White blood cells; (B) neutrophils; (C) monocytes; (D) lymphocytes; (E) platelets; (F) neutrophil-to-lymphocyte ratio; (G) monocyte-to-lymphocyte ratio; (H) platelet-to-lymphocyte ratio; (I) systemic inflammatory response index; (J) systemic inflammatory index; (K) aggregate index of systemic inflammation; (L) serum albumin; (M) prognostic nutritional index; (N) high-sensitivity C reactive protein. Cut-offs for inflammatory indicators were determined by the receiver operating characteristic analysis.
Figure 4
Figure 4
Subgroup analysis of inflammatory indicators (compared with their lower counterparts) (A–N) (A) White blood cells; (B) neutrophils; (C) monocytes; (D) lymphocytes; (E) platelets; (F) neutrophil-to-lymphocyte ratio; (G) monocyte-to-lymphocyte ratio; (H) platelet-to-lymphocyte ratio; (I) systemic inflammatory response index; (J) systemic inflammatory index; (K) aggregate index of systemic inflammation; (L) serum albumin; (M) prognostic nutritional index; (N) high-sensitivity C reactive protein. Abbreviations: ACS, acute coronary syndrome; BMI, body mass index; CCS, chronic coronary syndrome; CI, confidence interval; HR, hazard ratio; LDL-c, low-density lipoprotein cholesterol. Adjusted for age, sex, body mass index, acute coronary syndrome, prior coronary artery bypass grafting, prior stroke, diabetes, chronic kidney disease, left ventricular ejection fraction <40%, left main stem/three-vessel disease, and unsuccessful percutaneous coronary intervention. ∗ p for interaction <0.05.
Figure 5
Figure 5
Comparison of CIS in the PROMISE study and PCI-2013 cohort (A) Distributions of CIS in the PROMISE study (left panel) and PCI-2013 cohort (right panel). (B) Survival curves for patients stratified by levels of CIS in the PROMISE study (left panel) and PCI-2013 cohort (right panel). (C) Performance of SIRI, hsCRP, and CIS in predicting 2-year all-cause mortality in the PROMISE study (left panel) and PCI-2013 cohort (right panel). CIS was calculated as 0.209 × SIRI +0.485 × hsCRP. Abbreviations: AUC, area under the curve; CI, confidence interval; CIS, comprehensive inflammation score; hsCRP, high-sensitivity C-reactive protein; IDI, integrated discrimination improvement; NRI, net reclassification Improvement; PCI-2013, patients undergoing percutaneous coronary intervention in 2013 at Fuwai Hospital; PROMISE, the prospective observational multi-center cohort for ischemic and hemorrhage risk in coronary artery disease patients; SIRI, systemic inflammatory response index.
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