Cardiometabolic Index: a novel prognostic biomarker for recurrent stroke risk in acute ischemic stroke patients

Background Stroke remains a major global health problem, and recurrent stroke represents a serious complication in patients with acute ischemic stroke (AIS), which severely compromises patient prognosis and increases the socioeconomic burden on healthcare systems worldwide. Effective biomarkers for predicting major adverse cerebrovascular events (MACEs) after thrombolysis are urgently needed to optimize clinical management and improve long-term outcomes in AIS patients. Methods This study retrospectively enrolled 588 AIS patients who underwent thrombolytic therapy. The predictive efficiency of the Cardiometabolic Index (CMI) for long-term adverse cerebrovascular events was compared with that of traditional biomarkers. Multivariate analysis was performed to identify the independent correlation between CMI and MACE risk. Additionally, the mediating effect of systemic inflammation on the association between CMI and adverse outcomes was investigated. Results CMI demonstrated superior predictive performance for long-term adverse cerebrovascular events compared with conventional biomarkers in post-thrombolytic AIS patients. A high CMI value (≥0.80) was independently correlated with an increased risk of MACEs. Moreover, systemic inflammation partially mediated the predictive effect of CMI on adverse clinical outcomes. Conclusion CMI is a reliable and promising prognostic biomarker for predicting adverse cerebrovascular events in AIS patients after thrombolytic therapy. By comprehensively reflecting metabolic and inflammatory status, CMI provides better predictive capability and helps refine risk stratification and individualized treatment strategies. Further large-sample cohort studies are necessary to verify the clinical applicability of CMI and improve therapeutic regimens for AIS.