Key result
Elevated Castelli risk index II linked to ~30% greater repeat revascularization risk in young NSTEMI patients.
Why the study?
Repeat revascularization following PCI remains an important clinical concern in young patients, prompting evaluation of associated clinical and atherogenic factors in premature NSTEMI.
Is elevated Castelli Risk Index-II associated with an increased risk of repeat revascularization in young patients undergoing PCI for NSTEMI?
Observational (n=466)
No
Is elevated Castelli Risk Index-II associated with an increased risk of repeat revascularization in young patients undergoing PCI for NSTEMI?
Elevated Castelli Risk Index-II is independently associated with repeat revascularization in young patients undergoing PCI for NSTEMI, though its discriminatory power is modest.
Answers are grounded in this paper and cite their sources.
Elevated CRI-II may flag higher repeat revascularization risk after PCI in young NSTEMI patients; leaves open its added value for risk stratification or therapy guidance.
OBJECTIVE: Repeat revascularization following percutaneous coronary intervention (PCI) remains an important clinical concern in young patients. We evaluated the clinical and atherogenic factors associated with repeat revascularization in patients with premature non-ST-segment elevation myocardial infarction (NSTEMI) undergoing PCI. METHOD: This retrospective, single-center observational study included 466 consecutive patients younger than 45 years who underwent PCI for NSTEMI between January 2020 and December 2024. Atherogenic markers, including the atherogenic index of plasma (AIP), triglyceride-glucose (TyG) index, remnant cholesterol inflammation index (RCII), and Castelli risk indices I and II (CRI-I and CRI-II), were analyzed. The primary endpoint was repeat revascularization only. A nested multivariable Cox model was used to evaluate the incremental prognostic value of CRI-II beyond that of a baseline model. RESULTS: Repeat revascularization occurred in 73 individuals (16%) over a median follow-up of 37.2 (22.1-51.9) months, predominantly involving non-target vessel revascularization. Patients requiring repeat revascularization had significantly higher CRI-II levels (P = 0.03). CRI-II remained independently associated with repeat revascularization after adjustment, along with hypertension and bifurcation lesions (HR: 1.30, 95% CI: 1.09-1.55, P = 0.003; HR: 2.09, 95% CI: 1.27-3.45, P = 0.004; and HR: 2.26, 95% CI: 1.19-4.27, P = 0.01, respectively); the addition of CRI-II modestly improved discrimination (Harrell's C index: 0.684 to 0.694). High CRI-II was associated with significantly higher repeat revascularization rates in the Kaplan-Meier analysis (log-rank P < 0.0001). CONCLUSION: Elevated CRI-II was independently associated with repeat revascularization, along with hypertension and bifurcation lesions, in patients with premature NSTEMI undergoing PCI. However, CRI-II showed limited discriminatory performance, and its clinical utility for risk stratification requires external validation.
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Şengör et al. (2026) conducted an observational in Premature non-ST-segment elevation myocardial infarction (NSTEMI) undergoing PCI (n=466). Elevated Castelli risk index II (CRI-II) vs. Lower CRI-II was evaluated on Repeat revascularization (HR 1.30, 95% CI 1.09-1.55, p=0.003). Elevated Castelli risk index II was independently associated with repeat revascularization in young patients with NSTEMI undergoing PCI (HR 1.30; 95% CI 1.09-1.55; P=0.003).
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