Key result
Elevated baseline systemic immune-inflammation index linked to ~51% higher MACE risk after CTO PCI.
Why the study?
The prognostic role of the systemic immune-inflammation index (SII) in patients with chronic total occlusion undergoing PCI was not well established.
Does an elevated baseline Systemic Immune-Inflammation Index (SII) predict long-term major adverse cardiovascular events in patients with chronic total occlusion undergoing percutaneous coronary intervention?
Cohort (n=3,107)
No
Does an elevated baseline Systemic Immune-Inflammation Index (SII) predict long-term major adverse cardiovascular events in patients with chronic total occlusion undergoing percutaneous coronary intervention?
Hazard Ratio: 1.51 (95% CI 1.2–1.9)
Absolute Event Rate: 15.7% vs 8%
p-value: p=0.001
An elevated baseline Systemic Immune-Inflammation Index (SII) is an independent predictor of long-term major adverse cardiovascular events in patients with chronic total occlusion undergoing PCI, improving risk stratification beyond traditional factors.
Background: This large-scale cohort study aimed to evaluate the prognostic role of the systemic immune-inflammation index (SII) in patients with chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI). Methods: A total of 3107 patients with CTO lesions who underwent PCI were enrolled in this study. Clinical characteristics were collected, and post-discharge major adverse cardiovascular events (MACEs) were recorded during follow-up, including all-cause mortality, non-fatal myocardial infarction, unplanned revascularization, and heart failure-related readmission. Patients were stratified into three groups according to SII tertiles: the low SII group (SII ≤447.66, n = 1036), the intermediate SII group (447.66 < SII < 679.89, n = 1039), and the high SII group (SII ≥679.89, n = 1032). Results: Over a median follow-up of 2.58 (2.33–2.92) years, 356 (11.5%) MACEs occurred, including 49 (1.6%) all-cause deaths, 105 (3.4%) non-fatal myocardial infarctions, 164 (5.3%) revascularizations, and 38 (1.2%) heart failure rehospitalizations. Multivariable Cox regression analyses demonstrated that elevated SII was independently linked to higher risks of MACEs (hazard ratio [HR] = 1.51, 95% confidence interval [CI]: 1.20–1.90; p = 0.001), all-cause death (HR = 2.06, 95% CI: 1.11–3.84; p = 0.022), non-fatal myocardial infarction (HR = 1.76, 95% CI: 1.15–2.69; p = 0.009), and repeat revascularization (HR = 1.32, 95% CI: 1.01–1.76; p = 0.046) after full adjustment. Kaplan–Meier survival curves showed significantly higher rates of adverse events in patients with elevated SII. Adding SII to traditional risk models improved predictive performance, as reflected by increases in the concordance index (C-index), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Conclusions: Baseline SII is a reliable and independent predictor of MACEs in patients with CTO after PCI, with superior predictive performance compared with conventional inflammatory markers.
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Zhao et al. (2026) conducted a cohort in Chronic Total Coronary Occlusion (CTO) (n=3,107). Elevated systemic immune-inflammation index (SII) vs. Low systemic immune-inflammation index was evaluated on Major adverse cardiovascular events (MACEs) (HR 1.51, 95% CI 1.20-1.90, p=0.001). Elevated baseline systemic immune-inflammation index increased the risk of major adverse cardiovascular events (HR 1.51) in patients with chronic total coronary occlusion post-PCI.
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