Predictive Values of Systemic Immune-Inflammation Index in New-Onset Atrial Fibrillation Following Coronary Artery Bypass Grafting

Exploring Inflammatory Markers and Risk Factors Associated with Pericarditis Development after Ablation for Atrial Fibrillation

Background: This study aimed to explore the association between inflammatory markers and the occurrence of post-atrial fibrillation (AF) ablation pericarditis (PAP), while also examining the PAP's incidence and contributing factors. Methods: A retrospective cohort study was conducted between January 2021 and November 2023, including patients who underwent successful AF ablation. Inflammatory markers of interest included the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Results: Among the 231 patients examined, 22 (9.52%) were classified as suspected PAP, and 14 (6.06%) as definitive PAP. The median age was 58 years, with no age difference between groups. Males comprised 51.52% of the sample, with male sex frequency significantly higher in the suspected PAP group relative to the other groups (p = 0.007). Multivariable logistic regression indicated that AF duration (p = 0.026) and cavotricuspid isthmus (CTI) ablation (p = 0.001) were associated with definitive PAP, whereas analysis for any pericarditis (suspected or definitive PAP) revealed independent relationships with CTI ablation (p = 0.003) and sleep apnea (p = 0.008). SII, NLR, and PLR were not associated with PAP. Conclusions: Prolonged AF duration, CTI ablation, and sleep apnea are risk factors for PAP. The inflammatory markers (SII, NLR, and PLR) showed no association, warranting further investigation into other markers.

Increased Serum CRP-Albumin Ratio is Independently Associated With In-Stent Restenosis After Carotid Artery Stenting

Atherosclerotic stenosis of the carotid artery contributes significantly to ischemic strokes. This study investigates the correlation between the C-reactive protein (CRP) to albumin ratio (CAR) and in-stent restenosis (ISR) in patients (n = 529) undergoing carotid artery stenting. Patients were categorized based on ISR occurrence. Cox regression analyses were performed to identify independent predictors of ISR. The ISR rate was 10.3%. Laboratory analysis revealed higher levels of uric acid, CRP, and CAR in the ISR group. Cox regression identified CAR as an independent predictor of ISR (Hazard ratio (HR): 1.13, 95% CI: 1.03-1.24, P = .01), along with diabetes and smoking. A CAR cut-off of 0.28 predicted ISR with 93% sensitivity and 89% specificity (Area under the curve (AUC): 0.945, 95% CI: 0.923-0.963, P < .001). This study establishes a significant association between CAR and ISR in carotid artery stenting patients. The inflammatory response, indicated by CAR, emerges as a crucial factor in ISR development. The study contributes valuable insights into predicting and preventing ISR, emphasizing the potential of CAR as a prognostic biomarker. This easily accessible and cost-effective biomarker could enhance ISR prediction and guide preventive strategies for high-risk patients.

Effects of Preoperative Nutritional Status and Lymphocyte Count on the Development of Early-term Atrial Fibrillation After Coronary Artery Bypass Grafting: A Retrospective Study

INTRODUCTION

Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting.

METHODS

This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation.

RESULTS

The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002.

CONCLUSION

According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.

The Significance of Systemic Inflammatory Markers in 'New-Onset Atrial Fibrillation' Following Cardiac Surgeries

Postoperative atrial fibrillation (AF) is a known complication of postoperative morbidity and mortality in cardiac surgery. The purpose of this retrospective study was to look into the association between the incidence of new-onset AF in patients undergoing cardiac surgery and preoperative systemic inflammatory markers. Patients were divided into two groups (Group A: new-onset AF, Group B: no AF) depending on the occurrence of AF in the postoperative period, and a retrospective analysis was performed to look for the association between the incidence of new-onset AF and levels of systemic inflammatory markers. Five hundred patients were enrolled in the study, and the duration was three years. One-hundred and fifty out of 500 patients who underwent cardiac surgeries between 2020 and 2023 had higher levels of preoperative inflammatory markers. The systemic immune inflammation index (SII), neutrophil scores, platelet counts, and C-reactive protein (CRP) levels were examined. Compared to patients without AF (Group B), those who developed AF (Group A) had significantly higher mean levels of CRP (6.2 ± 1.8 mg/L), platelet count (320 ± 50 x109/L), neutrophil scores (4.6 ± 0.9), and SII (650 ± 120) (p<0.05 for all). Higher thresholds of these inflammatory markers were related to a notable increase in the prevalence of AF, with odds ratios showing significantly higher risks associated with raised marker levels. In summary, there was a significant correlation found between an increased risk of new-onset AF after surgery and elevated preoperative inflammatory markers, such as CRP levels, platelet counts, neutrophil scores, and SII. These findings could be used as prognostic markers to identify patients who are more likely to experience postoperative AF. Further prospective studies will be required to analyze their predictive value. Limitations of our study include the relatively small sample size, potential bias from single-institutional data, and the retrospective nature of the study design.

Systemic immune- inflammation index predicts post-MI left ventricular remodeling

AIMS

Previous studies demonstrated that remodeling after successful percutaneous coronary intervention (PCI) depends on the inflammatory response triggered by myocardial infarction (MI). The systemic immune-inflammation index (SII) is a novel inflammation index strongly associated with coronary artery disease. In our study, we sought to determine whether SII could predict Post-MI LV remodeling.

METHODS AND RESULTS

The study population included 528 patients (mean age 62.5 ± 10.2, 73% male) diagnosed with STEMI. Based on the increase in LVEDV within the first 12 months after STEMI, patients were divided into two groups. We categorized the ≥ 20% increase in LVEDV among remodelers (257 patients, 49%), and the other 271 patients (51%), as non-remodelers. To determine the relationship between laboratory parameters and LV remodeling, univariate and multivariate logistic regression models were used. In a univariate model, higher hs-CRP and SII values were associated with increased LVEDV. In a multivariate analysis, SII independently correlated with LV remodeling A cut-off value of 613.3 or higher for SII was significantly correlated with LV remodeling based on ROC analysis.

CONCLUSION

SII provides an easy-to-calculate and affordable biomarker for cardiovascular diseases. It may be used as a new biomarker to predict LV remodeling in patients with STEMI.

Systemic immune-inflammation index and in-stent restenosis in patients with acute coronary syndrome: a single-center retrospective study

BACKGROUND

In-stent restenosis (ISR) has been shown to be correlated with inflammation. This study aimed to examine the relationship between systemic immune-inflammation index (SII, an innovative inflammatory biomarker) and ISR in acute coronary syndrome (ACS) patients after drug-eluting stent (DES) implantation.

METHODS

Subjects who were diagnosed with ACS and underwent DES implantation were enrolled retrospectively. All individuals underwent follow-up coronary angiography at six to forty-eight months after percutaneous coronary intervention (PCI). SII was defined as [(platelet count × neutrophil count)/lymphocyte count], and Ln-transformed SII (LnSII) was carried out for our analysis. Multivariate logistic regression analysis was employed to assess the association between LnSII and DES-ISR.

RESULTS

During a median follow-up period of 12 (11, 20) months, 523 ACS patients who underwent follow-up angiography were included. The incidence of DES-ISR was 11.28%, and patients in the higher LnSII tertile trended to show higher likelihoods of ISR (5.7% vs. 12.1% vs. 16.0%; P = 0.009). Moreover, each unit of increased LnSII was correlated with a 69% increased risk of DES-ISR (OR = 1.69, 95% CI 1.04-2.75). After final adjusting for confounders, a significant higher risk of DES-ISR (OR = 2.52, 95% CI 1.23-5.17) was found in participants in tertile 3 (≥ 6.7), compared with those in tertiles 1-2 (< 6.7). Subgroup analysis showed no significant dependence on age, gender, body mass index, current smoking, hypertension, and diabetes for this positive association (all P for interaction > 0.05).

CONCLUSION

High levels of SII were independently associated with an increased risk of DES-ISR in ACS patients who underwent PCI. Further prospective cohort studies are still needed to validate our findings.

The Role of Pan-Immune-Inflammation Value in Determining the Severity of Coronary Artery Disease in NSTEMI Patients

BACKGROUND

Even though medication and interventional therapy have improved the death rate for non-ST elevation myocardial infarction (NSTEMI) patients, these patients still have a substantial residual risk of cardiovascular events. Early identification of high-risk individuals is critical for improving prognosis, especially in this patient group. The focus of recent research has switched to finding new related indicators that can help distinguish high-risk patients. For this purpose, we examined the relationship between the pan-immune-inflammation value (PIV) and the severity of coronary artery disease (CAD) defined by the SYNTAX score (SxS) in NSTEMI patients.

METHODS

Based on the SxS, CAD patients were split into three groups. To evaluate the risk variables of CAD, multivariate logistic analysis was employed.

RESULTS

The PIV (odds ratio: 1.003; 95% CI: 1.001-1.005; p = 0.005) was found to be an independent predictor of a high SxS in the multivariate logistic regression analysis. Additionally, there was a positive association between the PIV and SxS (r: 0.68; p < 0.001). The PIV predicted the severe coronary lesion in the receiver-operating characteristic curve analysis with a sensitivity of 91% and specificity of 81.1%, using an appropriate cutoff value of 568.2.

CONCLUSIONS

In patients with non-STEMI, the PIV, a cheap and easily measured laboratory variable, was substantially correlated with a high SxS and the severity of CAD.

A Prediction Model Based on Systemic Immune-Inflammatory Index Combined with Other Predictors for Major Adverse Cardiovascular Events in Acute Myocardial Infarction Patients

Objective

To evaluate the prognostic value of the systemic immune-inflammatory index (SII) for predicting in-hospital major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI) and establish a relevant nomogram.

Methods

This study included 954 AMI patients. We examined three inflammatory factors (SII, platelet to lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR)) to see which one predicts in-hospital MACEs better. The predictors were subsequently screened using bidirectional stepwise regression method, and a MACE nomogram was constructed via logistic regression analysis. The predictive value of the model was evaluated using the area under the curve (AUC), sensitivity and specificity. In addition, the clinical utility of the nomogram was evaluated using decision curve analysis. We also compared the nomogram with the Global Registry of Acute Coronary Events (GRACE) scoring system.

Results

334 (35.0%) patients had MACEs. The SII (AUC =0.684) had a greater predictive value for in-hospital MACEs in AMI patients than the PLR (AUC =0.597, P<0.001) or NLR (AUC=0.654, P=0.01). The area under the curve (AUC) of the SII-based multivariable model for predicting MACEs, which was based on the SII, Killip classification, left ventricular ejection fraction, age, urea nitrogen (BUN) concentration and electrocardiogram-based diagnosis, was 0.862 (95% CI: 0.833-0.891). Decision curve and calibration curve analysis revealed that SII-based multivariable model demonstrated a good fit and calibration and provided positive net benefits than the model without SII. The predictive value of the SII-based multivariable model was greater than that of the GRACE scoring system (P<0.001).

Conclusion

SII is a promising, reliable biomarker for identifying AMI patients at high risk of in-hospital MACEs, and SII-based multivariable model may serve as a quick and easy tool to identify these patients.

Systemic immune-inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis

Background

Postoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune-inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk.

Methods

To synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF.

Results

Eight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%-29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6-6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68-0.89) and 0.53 (95% CI, 0.23-0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74-0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74-0.81).

Conclusion

Elevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].

Novel Predictor of the AF Development in Patients with OSAS: Importance of Visceral Adipose Index

Objective

Obstructive sleep apnea syndrome (OSAS) is a sleep disorder whose frequency is increasing daily due to modern lifestyle. Patients with atrial fibrillation (AF), which has the same predisposing factors, frequently visit the outpatient clinic with complaints of palpitation. Existing symptoms are often associated with the course of OSAS, and the development of AF, a disease with high morbidity and mortality, cannot be detected. In our study, we investigated the relationship between the visceral adiposity index (VAI) and AF development in these patients.

Methods

We retrospectively analyzed 207 patients with OSAS who visited the cardiology outpatient clinic. The data of 44 patients with AF and 163 patients without AF were compared.

Results

Demographic characteristics and clinical risk factors were similar between the groups (p>0.05). VAI, apnea-hypopnea index, and inflammatory markers were higher in the AF group, and these risk factors were significant in the multivariate analysis (p<0.05).

Conclusions

Our study is important in terms of showing VAI as one of the most important predictors of AF, which has an impact on mortality and morbidity in patients with OSAS, whose frequency is increasing daily. Further prospective studies are required to confirm our observations and determine their clinical applicability.

Increased Serum Systemic Immune-Inflammation Index is Independently Associated With Severity of Carotid Artery Stenosis

Stroke is a significant contributor to morbidity and mortality. The present study investigated how the systemic immune inflammation index (SII) could be used to predict the likelihood of developing carotid artery stenosis (CAS), which can be seen using carotid artery angiography (CAAG). This study comprised 418 individuals who underwent CAAG for CAS. SII was calculated by multiplying the platelet count by the neutrophil/lymphocyte ratio (NLR). The patients were divided into two groups: non-critical and critical CAS (stenosis below %70 and above ≥70%, respectively). Compared with the non-critical CAS, the critical CAS group had greater high sensitivity C-reactive protein levels (4.5 [3.1-5.7] vs 3.9 [2-5] [mg/L], P < .001), NLR (4.1 [2.9-7.5] vs 2.9 [1.8-3.7], P < .001), platelet/lymphocyte ratio (233 [110-297] vs 119 [96-197], P < .001), and SII (860 [608-2455] vs 604 [458-740], P < .001). Receiver Operating Characteristic Curve analysis demonstrated the best cutoff value of 672.3 for SII to predict the critical CAS with 71.2% sensitivity and 60.1% specificity. According to our study, an increase in SII is an independent predictor of the severity of CAS in patients undergoing CAAG.

Circulating Levels of Ferritin, RDW, PTLs as Predictive Biomarkers of Postoperative Atrial Fibrillation Risk after Cardiac Surgery in Extracorporeal Circulation

Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery in conventional extracorporeal circulation (CECC), with an incidence of 15-50%. The POAF pathophysiology is not known, and no blood biomarkers exist. However, an association between increased ferritin levels and increased AF risk, has been demonstrated. Based on such evidence, here, we evaluated the effectiveness of ferritin and other haematological parameters as POAF risk biomarkers in patients subjected to cardiac surgery. We enrolled 105 patients (mean age = 70.1 ± 7.1 years; 70 men and 35 females) with diverse heart pathologies and who were subjected to cardiothoracic surgery. Their blood samples were collected and used to determine hematological parameters. Electrocardiographic and echocardiographic parameters were also evaluated. The data obtained demonstrated significantly higher levels of serum ferritin, red cell distribution width (RDW), and platelets (PLTs) in POAF patients. However, the serum ferritin resulted to be the independent factor associated with the onset POAF risk. Thus, we detected the ferritin cut-off value, which, when ≥148.5 ng/mL, identifies the subjects at the highest POAF risk, and with abnormal ECG atrial parameters, such as PW indices, and altered structural heart disease variables. Serum ferritin, RDW, and PTLs represent predictive biomarkers of POAF after cardiothoracic surgery in CECC; particularly, serum ferritin combined with anormal PW indices and structural heart disease variables can represent an optimal tool for predicting not only POAF, but also the eventual stroke onset.