Predictive Value of the Global Immune–Nutrition–Inflammation Index for Myocardial Infarction Risk in Patients with Unstable Angina and Type 2 Diabetes Mellitus

Background: Patients with unstable angina (UA) and type 2 diabetes mellitus (T2DM) face a high risk of myocardial infarction (MI) driven by systemic inflammation, immune dyshomeostasis, and metabolic derangements. This study evaluated the prognostic value of the global immune-nutrition-inflammation (GINI) index for predicting MI in this high-risk cohort. Methods: This retrospective, single-center observational study included 212 patients with unstable angina (UA) and type 2 diabetes mellitus (T2DM), stratified into MI (n=58) and non-MI (n=154) groups based on clinical progression. Biochemical assays were conducted to determine serum albumin, C-reactive protein, glycated hemoglobin, and serum lipid parameters. Hematological indices, including absolute neutrophil, lymphocyte, monocyte, and platelet counts, were also quantified. Baseline GINI, systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and prognostic nutritional index (PNI) were calculated. Predictive performance was assessed using multivariate logistic regression, receiver operating characteristic (ROC) curve analysis, and tertile-based risk stratification. Results: GINI was significantly elevated in the MI group compared to the non-MI group (1245.7 ± 315.6 vs 820.5 ± 210.3, P< 0.001) and correlated positively with hs-CRP, fasting glucose, and HbA1c (all P< 0.001). Multivariate analysis identified GINI as an independent predictor of MI (OR=1.003, P< 0.001). GINI demonstrated superior diagnostic accuracy (AUC=0.842) compared to SII, PIV, and PNI, with an optimal cutoff of 1025.4 yielding 81.0% sensitivity and 76.6% specificity. Furthermore, MI incidence escalated significantly across low, middle, and high GINI tertiles (11.4%, 25.0%, and 45.7%, respectively; P< 0.001). Conclusion: GINI is a robust, cost-effective biomarker that integrates inflammatory, immunological, and nutritional statuses. It offers superior prognostic value for the early identification of MI risk in patients with UA and T2DM, facilitating personalized risk stratification and targeted therapeutic interventions.