The Association Of Systemic Immune-inflammation Index And In-hospital Major Adverse Cardiovascular Events In Type B Aortic Dissection Patients Undergoing Thoracic Endovascular Repair

Objectives:We aimed to explore the relation of systemic immune-inflammation index(SII)with in-hospital major adverse cardiovascular events(MACEs)in type B aortic dissection(TBAD)patients undergoing thoracic endovascular repair(TEVAR).Methods:This is a single-center,observational,retrospective cohort study.According to the inclusion exclusion criteria,clinical data of 805 TBAD patients who underwent TEVAR at the cardiovascular department of Guangdong Provincial People’s Hospital were collected from January 2010 to December 2017.Baseline data of the study population and clinical outcomes during TEVAR hospitalization were obtained through review of the electronic medical records;follow-up data were obtained through electronic medical records,outpatient records and telephone contact.The primary outcome was in-hospital MACEs,including re-aortic related intervention after TEVAR and all-cause death.The patients were divided into two groups(high SII and low SII)as per the optimal cut-off value determined using the receiver operating characteristic curve.Multivariate logistic and cox regression analyses were performed to analyse the relationship between the SII and the in-hospital and follow-up MACEs.Results:A total of 805 TBAD patients who underwent TEVAR were enrolled.The patients were divided into the high-SII group[SII>1020,n=348(43.2%)]and the low-SII group[SII≤1020,n=457(56.8%)]as per the optimal cut-off value of 1020.There were no differences in age,sex,coronary artery disease,hypertension,diabetes,abdominal aortic aneurysm,and imaging findings between two groups.Patients in the high SII group had a significantly higher rate of renal insufficiency and anemia.Thirty-six(4.5%)patients developed MACEs during hospitalisation(in-hospital death:n=26;aortic related re-intervention:n=10).The high SII group suffered a significantly higher rate of MACEs,all-cause death,and aortic related re-intervention than the low SII group(P<0.05).Multivariable logistic analyses showed that SII>1020 was independently associated with in-hospital MACEs(odd ratio[OR],3.21;95%confidence interval[CI],1.50-6.88;P<0.01).During follow-up,98(12.6%)patients suffered MACEs(death:n=70;aortic related re-intervention:n=35).MACEs were significantly higher in high SII group than that in the low SII group(p<0.05).In addition,multivariable cox analyses showed that SII>1020 could be an independent indicator for follow-up MACEs(hazard ratio[HR],1.63;95%CI,1.09-2.45,P=0.02).ConclusionsAdmission SII is associated with in-hospital MACEs in patients with TBAD undergoing TEVAR.Therefore,SII may serve as valuable tool for risk stratification before intervention.