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. 2024 Oct 11;13(20):6059.
doi: 10.3390/jcm13206059.

Advanced Lung Cancer Inflammation Index as Predictor of All-Cause Mortality in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Giancarlo Trimarchi  1   2 , Fausto Pizzino  3 , Alessio Lilli  3 , Alberto Ranieri De Caterina  3 , Augusto Esposito  3 , Stefano Dalmiani  4 , Annamaria Mazzone  3 , Gianluca Di Bella  1 , Sergio Berti  3 , Umberto Paradossi  3
Affiliations

Advanced Lung Cancer Inflammation Index as Predictor of All-Cause Mortality in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

Giancarlo Trimarchi et al. J Clin Med. .

Abstract

Background: The advanced lung cancer inflammation index (ALI) is an independent prognostic biomarker used to assess inflammation and nutritional status in various cancers, heart failure, and acute coronary syndromes. This study investigates the prognostic significance of ALI in patients experiencing ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), comparing its predictive abilities with the established Neutrophil-Lymphocyte Ratio (NLR). Methods: We conducted a retrospective analysis of 1171 patients from the Matrix Registry, encompassing demographic and clinical data for STEMI cases treated with pPCI, and ALI was determined using the formula [serum albumin (g/dL) × body mass index (kg/m2)]/NLR at the time of hospital admission. The primary outcome was all-cause mortality. Results: Of the 1171 patients, 86 died during the follow-up period. Univariate analysis identified age, female gender, smoking, hypertension, diabetes, prior myocardial infarction (PMI), lower left ventricular ejection fraction (LVEF), and reduced ALI as factors associated with mortality. Multivariate analysis confirmed age (HR: 1.1, 95% CI: 1.05-1.11, p < 0.001) and PMI (HR: 2.4, 95% CI: 1.4-4.3, p = 0.001) as prominent independent predictors, alongside ALI (HR: 0.95, 95% CI: 0.92-0.97, p < 0.001) and LVEF (HR: 0.98, 95% CI: 0.97-0.99, p = 0.04). An ALI cut-off of ≤10 indicated a higher mortality risk (HR: 2.3, 95% CI: 1.5-3.7, p < 0.001). The area under the curve for ALI (0.732) surpassed that for NLR (0.685), demonstrating ALI's superior predictive capability. Conclusions: ALI is an independent prognostic factor for all-cause mortality in STEMI patients undergoing pPCI, showing greater discriminatory power than NLR, particularly in patients with ALI values ≤ 10, who face a 2.3-fold higher mortality risk.

Keywords: ST-elevation myocardial infarction; inflammation; malnutrition; mortality; neutrophil-to-lymphocyte ratio; primary PCI; vanced lung cancer inflammation index.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
ROC comparison between ALI and NLR, showing greater AUC for ALI vs. NLR (0.732 vs. 0.685; p < 0.001) and indicating that ALI had statistically significantly better discriminatory power than NLR for predicting death in this patient cohort. Abbreviations: ALI: advanced lung cancer inflammation index; AUC: area under the curve; NLR: neutrophil–lymphocyte ratio; ROC: receiver operating characteristic.
Figure 2
Figure 2
Forrest plot representing HR of multivariate analysis treating LVEF and ALI as discrete variables (with cut-offs at 35% and 10, respectively). Abbreviations: ALI: advanced lung cancer inflammation index; HR: hazard ratio; LVEF: left ventricular ejection fraction; MI: myocardial infarction.
Figure 3
Figure 3
Kaplan–Meier survival curves showing the different survival of STEMI patients according to ALI > 10 and ALI ≤ 10. Abbreviations: ALI: advanced lung cancer inflammation index.
See this image and copyright information in PMC

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