ASSOCIATION BETWEEN SYSTEMIC IMMUNEINFLAMMATION INDEX AND MORTALITY IN PATIENTS WITH NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Abstract

Objective Acute coronary syndrome (ACS) is a disease associated with high mortality and morbidity. It is essential to identify high-risk patients during hospitalization and to implement early revascularization strategies if necessary. There is a clear need for a simple, effective and cost-effective index for rapid identification of these patients in clinical practice. The aim of this study was to investigate the clinical significance of the systemic immune inflammation index (SII) in non-ST-segment elevation myocardial infarction (NSTEMI), a subgroup of ACS, and to evaluate its association with mortality. Material and Method Patients who underwent coronary angiography at the Coronary Angiography Unit of Aydın Adnan Menderes University Faculty of Medicine Research and Training Hospital between January and December 2022 were retrospectively reviewed. Individuals with a diagnosis of NSTEMI were included as group I, and individuals with normal coronary arteries during coronary angiography were included as group II (control group). Clinical variables and calculated SII values of the groups were recorded. The role of SII in predicting all-cause mortality and its effect on expected survival were evaluated. Results The median value of the SII index was significantly higher in the NSTEMI group (group I) than in the control group (group II) (p<0.001). The mean neutrophil and SII index values of the mortality group were significantly higher than those of the survival group (p=0.002 and p=0.019, respectively). Multivariate logistic regression showed that the presence of NSTEMI (odds ratio [OR]: 9.891; 95% CI: 2.096-46.671, p<0.001) and SII index (odds ratio [OR]: 1.001; 95% CI: 1.000-1001, p=0.039) independently predicted all-cause mortality. The cutoff point for the SII index was 609.98 using ROC curve analysis. Survival expectancy at 18 months was 68.1% for group I patients with SII >609.98 and 79.3% for group I patients with SII <609.98, but the difference was not statistically significant (p=0.426). Conclusion The SII score can help predict all-cause mortality in NSTEMI patients, but it is unsuitable for predicting survival.

Keywords

• SII
• mortality
• myocardial infarction

ST SEGMENT YÜKSELMESİZ MİYOKART ENFARKTÜS HASTALARINDA SİSTEMİK İMMÜN ENFLAMASYON İNDEKSİ VE MORTALİTE İLİŞKİSİ

Abstract

Amaç Akut koroner sendrom mortalitesi ve morbiditesi yüksek bir sendromdur. Yüksek riskli hastaların hastane yatışı esnasında belirlenmesi ve gerekli durumlarda erken revaskülarizasyon stratejilerinin uygulanması hastalarda hayati önem arz etmektedir. Klinik pratikte bu hastaların hızlıca belirlenmesine yönelik basit, etkili, maliyeti ucuz bir indeks ihtiyacı olduğu aşikardır. Tüm bu nedenlerden dolayı bu çalışmada tarafımızca SII’nın, AKS alt grubu olan NSTEMI geçiren hastalarda mortaliteyi ön görmedeki yerinin araştırılması amaçlanmıştır. Gereç ve Yöntem 01.01.2022-31.12.2022 tarihleri arasından Aydın Adnan Menderes Üniversitesi Tıp Fakültesi Uygulama ve Araştırma Hastanesi koroner anjiyografi ünitesinde koroner anjiyografi işlemi uygulanan hastalar geçmişe dönük olarak tarandı. St segment yükselmesiz miyokart enfarktüsü geçiren hastalarda ve normal koroner arterler saptanan hastalarda SII [(nötrofil x platelet) / lenfosit] hesaplandı. Bu indeks ile tüm nedenlere bağlı mortalite gelişimi arasında ilişki olup olmadığı araştırıldı. Bulgular Grup 1 olarak değerlendirilen NSTEMI grubu SII indeks ortancası Grup II’ye göre anlamlı düzeyde yüksek bulundu (p<0.001). Mortalite gözlenen gruba ait nötrofil ve SII indeksi değerleri ortalaması, sağkalım grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (sırasıyla p=0.002 ve p=0.019). Çok yönlü lojistik regresyon sonucunda, NSTEMI varlığı yaş (odds ratio [OR]: 9.891; 95% CI: 2.096-46.671, p<0.001) ve SII indeksinin (odds ratio [OR]: 1.001; 95% CI: 1.000-1001, p=0.039) tüm nedenlere bağlı mortaliteyi bağımsız olarak öngördüğü saptandı. NSTEMI grubunda SII indeksi 609.98 değerinden yüksek olguların sağkalım beklentisi 18 ay için %68.1, SII indeksi 609.98 değerinden düşük olgular için ise %79.3 olarak hesaplandı ancak fark istatistiksel olarak anlamlı bulunmadı (p=0.426). Sonuç SII, NSTEMI hasta grubunda mortaliteyi ön görmede faydalı bir indeks olmasına rağmen sağ kalımı öngörmede yeterli değildir.

Keywords

• SII
• mortalite
• miyokart enfarktüsü

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