The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department

Q: What are the key findings of this study?

Each one-unit increase in the EASIX index was associated with a 16% higher risk of in-hospital major adverse cardiovascular events (OR 1.16) in patients with acute myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=805). Intervention: Endothelial activation and stress index (EASIX) vs. Lower EASIX levels. Primary outcome: Incidence of major adverse cardiovascular events (MACE) (OR 1.16, 95% CI 1.04-1.29, p=0.0054).

Q: What does this research mean for the field?

Each one-unit increase in the endothelial activation and stress index (EASIX) is associated with a 16% higher risk of major adverse cardiovascular events in patients with acute myocardial infarction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Yan Cao; Bowen Xiong; Zeng Tangyi; Liudang He; Yingjie Su; Ning Ding

doi:10.1186/s12873-026-01682-w

August 1, 2026BMC Emergency MedicineOpen Access

The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department

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Key result

Higher EASIX score linked to ~16% increased in-hospital MACE risk per unit in AMI.

OR 1.16
95% CI 1.04-1.29
P=0.0054
n=805

Why the study?

To explore the relationship between the endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients.

Does a higher endothelial activation and stress index (EASIX) predict the incidence of major adverse cardiovascular events in patients with acute myocardial infarction?

Key Points

To evaluate the relationship between the endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in patients presenting with acute myocardial infarction.
Analyzed clinical records of 805 acute myocardial infarction patients (612 non-MACE and 193 MACE cases) admitted to an emergency department from August 2020 to January 2023.
Evaluated the association between EASIX and MACE using multivariable logistic regression adjusting for demographic, clinical, and laboratory covariates.
Assessed dose-response linearity using restricted cubic spline analysis and evaluated prognostic performance via receiver-operator characteristic curves.
After adjusting for potential confounders, each unit increase in EASIX was associated with a 16% higher risk of MACE (OR = 1.16, 95%CI: 1.04–1.29, p = 0.0054).
MACE incidence increased significantly across EASIX quartiles: 13.93% in Q1 (<0.90), 14.43% in Q2 (0.90-1.67), 24.88% in Q3 (1.68-2.82), and 42.57% in Q4 (>2.82) (P<0.001).
ROC analysis showed an AUC of 0.687 (95%CI: 0.642–0.732) for predicting MACE risk, with an optimal cut-off value of 2.42.

Study Design

Type

Cohort (n=805)

Multicenter

No

Structured PICO

Does a higher endothelial activation and stress index (EASIX) predict the incidence of major adverse cardiovascular events in patients with acute myocardial infarction?

P

Population

805 patients with acute myocardial infarction admitted to a single emergency department in China, evaluated for the incidence of in-hospital major adverse cardiovascular events.

E

Exposure

Endothelial activation and stress index (EASIX) evaluated as a continuous variable and in quartiles

C

Comparator

Lower quartiles of EASIX index or continuous comparison

O

Outcome

Major adverse cardiovascular events (MACE) during hospitalization, defined as a composite of cardiogenic shock, malignant arrhythmias (ventricular tachycardia, ventricular fibrillation, cardiac arrest, IIIo atrioventricular block), and acute heart failurecomposite

Main Result

Odds Ratio: 1.16 (95% CI 1.04–1.29)

p-value: p=0.0054

Limitations

Single-center retrospective design may influence generalizability
Selection bias due to exclusion of patients with missing data
Cannot establish causality between EASIX and MACE
EASIX is not specific to cardiovascular endothelial function and may be affected by comorbidities or treatments
Missing data on important prognostic factors like Killip class, LVEF, and GRACE/TIMI scores
Potential collinearity between EASIX components
Modest discrimination (AUC < 0.7) and potential overfitting of the cutoff value

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Implication

The EASIX index is a significant and independent predictor of in-hospital major adverse cardiovascular events in patients with acute myocardial infarction.

Abstract

In this study, we aimed to explore the relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events (MACE) in acute myocardial infarction (AMI) patients. This retrospective study was based on the clinical data of the AMI patients admitted in emergency department of Changsha Central Hospital from August 2020 to January 2023. Different models were constructed by multivariable regression analysis for investigating the relationship between EASIX index and MACE risk. Restricted cubic spline (RCS) analysis was utilized for further validating the potential nonlinear relationship. The receiver-operator characteristic (ROC) analysis of EASIX index for predicting MACE risk in AMI was done. 805 AMI patients with 193 individuals in MACE group were included. After adjusting potential confounders, with per unit increasement in EASIX index, the risk of MACE increased by 16% (OR = 1.16, 95%CI: 1.04–1.29, p = 0.0054). The RCS showed the nonlinear relationship between EASIX index and the incidence of MACE was not significant. The predictive performances of EASIX index were showed as follow: an AUC of 0.687 (95%CI:0.642–0.732) and a cut-off value of 2.42. A significant relationship between EASIX index and the incidence of MACE in AMI was identified.

Discussion

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Cite This Study

Cao et al. (2026) conducted a cohort in Acute myocardial infarction (n=805). Endothelial activation and stress index (EASIX) vs. Lower EASIX levels was evaluated on Incidence of major adverse cardiovascular events (MACE) (OR 1.16, 95% CI 1.04-1.29, p=0.0054). Each one-unit increase in the EASIX index was associated with a 16% higher risk of in-hospital major adverse cardiovascular events (OR 1.16) in patients with acute myocardial infarction.

synapsesocial.com/papers/6a705b9c75942ff7265e5a63 https://doi.org/10.1186/s12873-026-01682-w

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The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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