A novel inflammation indicator of acute stent thrombosis and in-hospital mortality in acute coronary syndrome: multiple inflammation index

Year 2023, , 168 - 175, 27.03.2023

Birsen Doğanay , Ozlem Ozcan Celebi

https://doi.org/10.47582/jompac.1256573

Cited By: 1

Abstract

Aim: The inflammatory milieu plays a triggering role in the development of acute stent thrombosis (ST), which occurs as a catastrophic complication following percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). This study aimed to investigate the prognostic role of multi-inflammatory index (MII), a powerful new marker of inflammation, in predicting of high SYNTAX score, acute ST and in-hospital mortality in patients with ACS undergoing PCI.
Material and Method: This retrospective study included 1488 consecutive patients with ACS undergoing PCI, and definitive ST was determined according to Academic Research Consortium criteria. Inflammation indices were calculated as follows: Systemic immune inflammation (SII)=neutrophil×platelet/lymphocyte ratio, CAR=CRP/albumin ratio, MII-1=platelet×CRP/lymphocyte ratio, MII-2=neutrophil×CRP/lymphocyte ratio, MII-3=SII×CRP.
Results: The incidence of acute ST was 3.6%. All inflammation indices was higher in the acute ST group and high SYNTAX score group. Multivariable regression analysis showed that MII-3 independent predictors of acute ST and high SYNTAX score. MII-3 exhibited better diagnostic performance than other inflammatory indices. The threshold value of MII-3 in predicting acute ST was >9084 (AUC=0.842, sensitivity=87.3%, specificity=%77.8) and patients with MII-3 >9084 had a 3.73-fold greater risk of mortality.
Conclusion: MII-3 is a stronger predictor of acute ST following PCI and it is associated with an increased risk of mortality. MII may be an essential prognostic screening tool for identifying high-risk patients prior to procedure.

Keywords

Acute coronary syndrome, inflammation, stent thrombosis, SYNTAX score

Akut koroner sendromda akut stent trombozunun ve hastane içi mortalitenin yeni bir inflamasyon göstergesi: çoklu inflamasyon indeksi

Abstract

Amaç: Akut koroner sendromlu (AKS) hastalarda perkütan koroner girişim (PKG) sonrası katastrofik bir komplikasyon olarak ortaya çıkan akut stent trombozu (ST) gelişiminde inflamatuar ortam tetikleyici rol oynayabilir. Bu çalışma, PKG uygulanan AKS'li hastalarda güçlü bir yeni inflamasyon belirteci olan multi-inflamatuar indeksin (MII) yüksek SYNTAX skoru, akut ST ve hastane içi mortaliteyi öngörmede prognostik rolünü araştırmayı amaçladı.
Gereç ve Yöntem: Bu retrospektif çalışma, PKG uygulanan ardışık 1488 AKS hastasını içermektedir ve kesin ST, Akademik Araştırma Konsorsiyumu kriterlerine göre belirlenmiştir. İnflamasyon indeksleri şu şekilde hesaplandı: Sistemik immün inflamasyon (SII) = nötrofil × trombosit / lenfosit oranı, CAR= CRP / albümin oranı, MII-1 = trombosit × CRP / lenfosit oranı, MII-2 = nötrofil × CRP / lenfosit oranı, MII-3 = SII × CRP.
Bulgular: Akut ST insidansı %3.6 idi. Tüm inflamasyon indeksleri akut ST grubunda ve SYNTAX skoru yüksek grupta daha yüksekti. Çok değişkenli regresyon analizi, MII-3'ün akut ST ve yüksek SYNTAX skorunun bağımsız belirleyicileri olduğunu gösterdi. MII-3, diğer inflamatuar indekslerden daha iyi teşhis performansı sergiledi. MII-3'ün akut ST'yi öngörme eşik değeri >9084 (EAA= 0,842, duyarlılık= %87,3, özgüllük= %77,8) olarak saptandı ve MII-3 >9084 olan hastalarda ölüm riski 3,73 kat daha fazla belirlendi.
Sonuç: MII-3, PKG sonrası akut ST'nin daha güçlü bir göstergesidir ve artmış mortalite riski ile ilişkilidir. MII, prosedürden önce yüksek riskli hastaları belirlemek için önemli bir prognostik tarama aracı olabilir.

Keywords

Akut koroner sendrom, inflamasyon, stent trombozu, SYNTAX skoru

Supporting Institution

Yok

References

• Zhu MM, Feit A, Chadow H, Alam M, Kwan T, Clark LT. Primary stent implantation compared with primary balloon angioplasty for acute myocardial infarction: a meta-analysis of randomized clinical trials. Am J Cardiol 2001; 88: 297-301.
• D’Ascenzo F, Bollati M, Clementi F, et al. Incidence and predictors of coronary stent thrombosis: evidence from an international collaborative meta-analysis including 30 studies, 221,066 patients, and 4276 thromboses. Int J Cardiol 2013; 167: 575-84.
• Ishihara T, Okada K, Kida H, et al. Long-term outcomes and clinical predictors of mortality following occurrence of stent thrombosis. J Am Heart Assoc 2022; 11: e023276.
• Tariq S, Kumar R, Fatima M, Saghir T, Masood S, Karim M. Acute and sub-acute stent thrombosis: Frequency, predictors and features in patients undergoing primary percutaneous intervention at a tertiary care cardiac centre. Int J Cardiol Heart Vasc 2020; 26: 100427.
• Inoue T, Croce K, Morooka T, Sakuma M, Node K, Simon DI. Vascular inflammation and repair: implications for re-endothelialization, restenosis, and stent thrombosis. JACC Cardiovasc Interv 2011; 4: 1057-66.
• Ochijewicz D, Tomaniak M, Opolski G, Kochman J. Inflammation as a determinant of healing response after coronary stent implantation. Int J Cardiovasc Imaging 2021; 37: 791-801.
• Cubedo J, Blasco A, Padro T, et al. Molecular signature of coronary stent thrombosis: oxidative stress and innate immunity cells. Thromb Haemost 2017; 117: 1816-27.
• Cornelissen A, Vogt FJ. The effects of stenting on coronary endothelium from a molecular biological view: Time for improvement? J Cell Mol Med 2019; 23: 39-46.
• Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest 2020; 50: e13230.
• Ye Z, Hu T, Wang J, et al. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis. Front Cardiovasc Med 2022; 9: 933913.
• Casadei Gardini A, Scarpi E, Valgiusti M, et al. Prognostic role of a new index (multi inflammatory index) in patients with metastatic colorectal cancer: results from the randomized ITACa trial. Ther Adv Med Oncol 2020; 12: 1758835920958363.
• Gozdas HT, Kayis SA, Damarsoy T, et al. Multi-inflammatory index as a novel mortality predictor in critically Ill COVID-19 patients. J Intensive Care Med 2022; 37: 1480-5.
• Boyuk F. The role of the multi-inflammatory index as a novel inflammation-related index in the differential diagnosis of massive and non-massive pulmonary embolism. Int J Clin Pract 2021; 75: e14966.
• Thygesen K, Alpert JS, Jaffe AS, et al. Fourth Universal Definition of Myocardial Infarction (2018). Glob Heart 2018; 13: 305-38.
• Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018; 39: 119-77.
• Buchanan GL, Basavarajaiah S, Chieffo A. Stent thrombosis: incidence, predictors and new technologies. Thrombosis 2012; 2012: 956962.
• Reejhsinghani R, Lotfi AS. Prevention of stent thrombosis: challenges and solutions. Vasc Health Risk Manag 2015; 11: 93-106.
• Cutlip DE, Baim DS, Ho KK, et al. Stent thrombosis in the modern era: a pooled analysis of multicenter coronary stent clinical trials. Circulation 2001; 103: 1967-71.
• van Werkum JW, Heestermans AA, Zomer AC, et al. Predictors of coronary stent thrombosis: the Dutch Stent Thrombosis Registry. J Am Coll Cardiol 2009; 53: 1399-409.
• Fuchs FC, Ribeiro JP, Fuchs FD, et al. Syntax score and major adverse cardiac events in patients with suspected coronary artery disease: results from a cohort study in a university-affiliated hospital in Southern Brazil. Arq Bras Cardiol 2016; 107: 207-15.
• Yadav M, Genereux P, Palmerini T, et al. SYNTAX score and the risk of stent thrombosis after percutaneous coronary intervention in patients with non-ST-segment elevation acute coronary syndromes: an ACUITY trial substudy. Catheter Cardiovasc Interv 2015; 85: 1-10.
• Ceresnakova M, Murray D, Soulimane T, Hudson SP. Candidates for smart cardiovascular medical device coatings: A comparative study with endothelial and smooth muscle cells. Eur J Pharmacol 2021; 910: 174490.
• Kritharides L. Inflammatory markers and outcomes in cardiovascular disease. PLoS Med 2009; 6: e1000147.
• Akboga MK, Inanc IH, Sabanoglu C, et al. Systemic immune-inflammation index and C-reactive protein/albumin ratio could predict acute stent thrombosis and high SYNTAX score in acute coronary syndrome. Angiology 2022: 33197221125779.
• Katayama T, Nakashima H, Takagi C, et al. Predictors of sub-acute stent thrombosis in acute myocardial infarction patients following primary coronary stenting with bare metal stent. Circ J 2006; 70: 151-5.
• Acet H, Guzel T, Aslan B, Isik MA, Ertas F, Catalkaya S. Predictive value of C-reactive protein to albumin ratio in ST-segment elevation myocardial infarction patients treated with primary percutaneous coronary intervention. Angiology 2021; 72: 244-51.
• Badimon L, Pena E, Arderiu G, et al. C-reactive protein in atherothrombosis and angiogenesis. Front Immunol 2018; 9: 430.
• Eligini S, Porro B, Aldini G, Colli S, Banfi C. N-acetylcysteine inhibits platelet function through the regeneration of the non-oxidative form of albumin. antioxidants (Basel) 2022; 11: 445.
• Ehlting C, Wolf SD, Bode JG. Acute-phase protein synthesis: a key feature of innate immune functions of the liver. Biol Chem 2021; 402: 1129-45.
• Kukula K, Klopotowski M, Kunicki PK, et al. Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome. BMC Cardiovasc Disord 2016; 16: 252.
• Ocal L, Keskin M, Cersit S, et al. Systemic immune-inflammation index predicts in-hospital and long-term outcomes in patients with ST-segment elevation myocardial infarction. Coron Artery Dis 2022; 33: 251-60.