Correlations Between Acute Coronary Syndrome and Novel Inflammatory Markers (Systemic Immune-Inflammation Index, Systemic Inflammation Response Index, and Aggregate Index of Systemic Inflammation) in Patients with and without Diabetes or Prediabetes

Abstract

Purpose

Type 2 diabetes mellitus (DM) is a recognized independent risk factor for both chronic coronary syndrome (CCS) and its complication, acute coronary syndrome (ACS). Patients with DM and prediabetes (preDM) face an increased ACS risk. Inflammation plays a significant role in the pathogenesis of both CCS and ACS. This study delves into novel inflammatory markers, such as the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI, also known as SIIRI or PIV), to explore their relationship with ACS and CCS in patients that have been or have not been diagnosed with DM or preDM.

Patients and Methods

This study included data of 493 patients with chest pain undergoing coronary angiography. They were categorized into four groups: 1) without DM/preDM and with CCS; 2) with both DM/preDM and CCS; 3) without DM/preDM and with ACS, 4) with both DM/preDM and ACS. Standard methods of statistical analysis were used to reveal possible differences between groups and to find the most influential ACS risk factors in groups with DM/preDM and without DM/preDM.

Results

The analysis showed no significant differences in SII, SIRI, or AISI between the respective patient groups. A logistic regression analysis generated a model incorporating SII, high-density lipoprotein, and low-density lipoprotein levels as the influential ACS risk factors for patients with DM/preDM. The model demonstrated 71.0% accuracy, 37.0% sensitivity, and 89.4% specificity.

Conclusion

The findings suggest that the aforementioned inflammatory markers may have potential for distinguishing DM/preDM patients at higher risk of ACS at a low financial cost. However, further comprehensive and well-designed research is required to validate their clinical utility.

Plain Language Summary

People with type 2 diabetes (DM) and prediabetes (preDM) have a higher risk of heart problems. These include chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). Inflammation is a key element in these issues. We looked at 493 patients with chest pain. We divided them into groups based on diabetes status (DM/preDM vs no diabetes) and heart conditions (ACS and CCS). We explored new markers related to inflammation. These include the systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) that all can be calculated from simple blood tests. We found no differences in these markers between groups. To understand ACS risk factors better, we used statistical analysis. The model found key factors for patients with DM/preDM: SII, LDL, and low-density lipoprotein levels. It was accurate (71.0%), but sensitivity was 37.0%, and specificity was 89.4%. These markers could be helpful in identifying DM/preDM patients at risk of ACS with low cost tests. We need more research to confirm their use in real-life medical settings.

Keywords:

• coronary artery disease
• ischemic heart disease
• atherosclerosis
• myocardial infarction
• pan-immune-inflammation value
• systemic immune-inflammation response index
• systemic immune-inflammation index
• diabetes

Abbreviations

ACS, acute coronary syndrome; AISI, aggregate index of systemic inflammation; AUC, area under the curve; CCS, chronic coronary syndrome; CRP, C-reactive protein; DBP, diastolic blood pressure; DM, type 2 diabetes mellitus; ESR, erythrocyte sedimentation rate; FPG, fasting plasma glucose; HDL, high-density lipoprotein; HTN, hypertension; IQR, interquartile range; LDL, low-density lipoprotein; MACE, major adverse cardiovascular events; MI, myocardial infarction; OGTT, oral glucose tolerance test; PCI, percutaneous coronary intervention; preDM, prediabetes; SBP, systolic blood pressure; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index; TC, total cholesterol; TG, triglycerides; WBC, white blood cells.

Acknowledgments

This research was partly supported by a statutory grant to the Cardiology Clinic of Physiotherapy Division from the 2nd Faculty of Medicine, Medical University of Warsaw, Poland (grant number: 2F5/PM2/16). The APC was funded by the Center of Postgraduate Medical Education.

Disclosure

All authors report no conflicts of interest in this work.