Prognostic value of endothelial activation and stress index in chronic coronary syndrome patients with prediabetes

AIM: Chronic coronary syndrome (CCS) is important in terms of cardiovascular events and mortality risk. Pre-diabetes is associated with endothelial dysfunction and adverse cardiovascular outcomes; however, practical biomarkers for risk stratification in these patients are limited. This study aimed to investigate the prognostic value of the Endothelial Activation and Stress Index (EASIX) in patients with CCS and pre-diabetes. MATERIALS AND METHODS: This single-center, retrospective cohort study included 1,437 patients with CCS and prediabetes between 2020-2024. The EASIX was calculated with laboratory parameters. The primary endpoint was MACE, defined as composite of cardiovascular death, non-fatal myocardial infarction, stroke, and target vessel revascularization. The secondary endpoint was all-cause mortality. Cox regression analysis, ROC-curve analysis and Kaplan- Meier survival analyses were performed. RESULTS: During a mean follow-up of 576 days, MACE occurred in 20.5% of patients and all-cause mortality in 5.2%. Higher EASIX was independently associated with increased risks of MACE (HR:1.110, 95% CI:1.009-1.222) and all-cause mortality (HR:1.205, 95% CI:1.044-1.390). ROC analysis demonstrated good discriminative ability for all-cause mortality prediction (AUC:0.779) and MACE (AUC:0.751). CONCLUSIONS: EASIX is independent and clinically meaningful predictor of adverse outcomes in patients with CCS and prediabetes and may serve as practical tool for residual cardiovascular risk stratification.