Predictive Value Of Systemic Immune-inflammation Index Combined With Modified Shock Index In Patients With STEMI For In-hospital MACE After Primary PCI

Objective:To investigate the risk factors for hospital major adverse cardiovascular events(MACE)in acute ST-segment elevation myocardial infarction(STEMI)treated with primary percutaneous coronary intervention(PCI)and to assess and compare the predictive value of systemic immune-inflammation index(SII),modified shock index(MSI),and the combination of hospital major adverse cardiovascular events in such patients.Methods:Patients with STEMI undergoing primary PCI at the Cardiovascular Medicine Department of Cardiology of the First Hospital of Jilin University from November 2020 to July 2022 were continually included.The final decision to select 1024 eligible patients as research subjects was made based on the inclusion and exclusion criteria.Basic patient data,auxiliary examination indicators,coronary angiography results,the occurrence of MACE,etc.,were all collected using the electronic medical record system.With the data gathered,we calculated the SII and MSI.Depending on whether MACE occurred in a hospital,the patients were divided into MACE and non-MACE groups.Clinical data,SII,and MSI levels were compared between the two groups.A logistic regression analysis model was used to identify the independent risk factors for MACE events in hospitals following primary PCI in patients with STEMI.To predict the incidence of MACE between the two groups,the best cut-off values for SII and MSI were calculated according to ROC,and the patients were divided into two groups based on the best cut-off values.ROC analysis was used to determine the predictive value of SII,MSI,and their combination to the occurrence of MACE in the hospital following primary PCI in patients with STEMI.To analyze the total incidence of MACE among the four groups,SII and MSI were combined in pairs.Statistical Package for Social Sciences 25.0 was used to analyze all the data statistically.P<0.05 was considered statistically significant.Reselts:1.This study studied 1024 patients with STEMI who met the inclusion and exclusion criteria.There were 140 patients in the MACE group and 884 patients in the non-MACE group.Age,hypertension,diabetes,previous cerebrovascular disease,NE,LY,PLT,SII,Cr,ALT,FBG,UA,peak c Tn I I,LVEF,LVEDD,admission SBP,admission DBP,admission HR,MSI,and multi-vessel lesions were all significantly different between the two groups(all P<0.05).2.According to the multivariate logistic regression analysis results,age,high SII,high ALT,high FBG,low LVEF,high LVEDD,high MSI were all independent risk factors for MACE during hospitalization following primary PCI in patients with STEMI(all P<0.05).3.According to the ROC analysis results,the AUC predicted by SII for in-hospital MACE in patients with STEMI receiving primary PCI treatment was 0.759 [95% confidence interval(CI):0.717-0.801,P<0.001].The best cut-off value was 1994.53,with a sensitivity and specificity of 66.4% and 74.7%,respectively.The incidence of MACE was higher in the high SII group than in the low SII group,and the difference was statistically significant(P <0.001)when the groups were compared based on the best cut-off value for SII.MSI predicted the AUC for in-hospital MACE in patients with STEMI was 0.627(95%CI:0.578-0.675,P<0.001)after receiving primary PCI treatment.The best cut-off value was0.86,with a sensitivity and specificity of 62.1% and 61%,respectively.The incidence of MACE was higher in the high MSI group than in the low MSI group,and the difference was statistically significant,according to the comparison between the groups created using the best cut-off value of MSI(P<0.001).4.The ROC analysis revealed that the sensitivity was 60% and the specificity was82.4%,with the AUC of SII and MSI combined for MACE during hospitalization 0.770(95% CI:0.727-0.813,P<0.001).The two combined had a higher AUC than the single index.Additional grouping analysis revealed that the high SII and high MSI group had a higher incidence of MACE than the high SII and low MSI group,low SII and high MSI group,and low SII and low MSI group.In conclusion,the two provide a stronger predictive value for MACE in the hospital in patients with STEMI than a single index.Conclusion:1.In patients with STEMI hospitalized after primary PCI,age,high SII,high ALT,high FBG,low LVEF,and high LVEDD,high MSI were all independent risk factors for MACE.2.When used together,SII and MSI have a higher predictive value than a single index for MACE in the hospital following primary PCI in patients with STEMI.