Prognostic Value of Systemic Immune-Inflammation Index (SIII) in Predicting Major Adverse Cardiac Events (MACE) in Patients Undergoing Percutaneous Coronary Intervention (PCI): An Observational Study

Q: What are the key findings of this study?

Each one-quartile increase in the Systemic Immune-Inflammation Index independently increased the odds of in-hospital MACE after PCI (adjusted OR 5.36, 95% CI 2.06–13.98; p=0.001).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Stable angina or acute coronary syndromes undergoing percutaneous coronary intervention (PCI) (n=400). Intervention: Systemic Immune-Inflammation Index (SII) per 1-quartile increase vs. Lower SII quartiles. Primary outcome: In-hospital major adverse cardiovascular events (MACE: composite of all-cause mortality, non-fatal myocardial infarction, and ischemic stroke) (OR 5.36, 95% CI 2.06-13.98, p=0.001).

Q: What does this research mean for the field?

An elevated pre-procedural Systemic Immune-Inflammation Index independently predicts in-hospital major adverse cardiovascular events in patients undergoing percutaneous coronary intervention. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

Sonali Gambhire; Rupesh Agrawal; Sunil Washimkar; Pradeep Deshmukh

doi:10.21203/rs.3.rs-11166407/v1

November 1, 2026Open Access

Prognostic Value of Systemic Immune-Inflammation Index (SIII) in Predicting Major Adverse Cardiac Events (MACE) in Patients Undergoing Percutaneous Coronary Intervention (PCI): An Observational Study

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Key result

Higher Systemic Immune-Inflammation Index linked to ~5.4-fold higher odds of post-PCI MACE per quartile.

OR 5.36
95% CI 2.06-13.98
P=0.001
n=400

Why the study?

MACE continue after PCI despite advances in revascularisation, and systemic inflammation contributes to atherosclerosis and plaque instability. This study evaluated the prognostic value of the Systemic Immune-Inflammation Index (SII), a biomarker derived from routine blood counts, for MACE after PCI.

Does the pre-procedural Systemic Immune-Inflammation Index (SII) predict in-hospital major adverse cardiovascular events (MACE) in adult patients undergoing percutaneous coronary intervention (PCI)?

Key Points

Evaluate the prognostic value of the pre-procedural systemic immune-inflammation index for predicting in-hospital major adverse cardiovascular events in patients undergoing percutaneous coronary intervention.
Single-center retrospective observational study of 400 consecutive adults undergoing percutaneous coronary intervention for stable angina or acute coronary syndromes over 1 year.
Pre-procedural complete blood counts were evaluated to calculate the systemic immune-inflammation index [(platelet × neutrophil) / lymphocyte], with patients stratified into quartiles.
Assessed in-hospital major adverse cardiovascular events (all-cause mortality, reinfarction, and stroke) using receiver operating characteristic curves and multivariable logistic regression.
In-hospital major adverse cardiovascular events occurred in 6.8% (n = 27) of patients, with significantly higher index values observed in affected patients compared to event-free patients (1127.19 ± 335.99 vs. 599.92 ± 324.55 ×10⁹/L; p < 0.001).
Receiver operating characteristic analysis demonstrated high predictive accuracy for adverse events (AUC 0.886; 95% CI 0.827–0.945; p < 0.001), with an optimal cut-off value of ≥ 776 ×10⁹/L yielding 85.2% sensitivity and 77.5% specificity.
Multivariable logistic regression identified the systemic immune-inflammation index (adjusted OR 5.36 per quartile increase, 95% CI 2.06–13.98; p = 0.001) and diabetes mellitus (adjusted OR 4.41, 95% CI 1.22–16.00; p = 0.024) as independent predictors of adverse events.

Study Design

Type

Cohort (n=400)

Multicenter

No

Structured PICO

Does the pre-procedural Systemic Immune-Inflammation Index (SII) predict in-hospital major adverse cardiovascular events (MACE) in adult patients undergoing percutaneous coronary intervention (PCI)?

P

Population

400 consecutive adults (24.3% female) undergoing PCI for stable angina or acute coronary syndromes at a single center in India over 12 months, followed for in-hospital outcomes.

E

Exposure

Pre-procedural Systemic Immune-Inflammation Index (SII), calculated as [(platelet count × neutrophil count) / lymphocyte count] from routine complete blood counts, stratified into quartiles: Q1 (≤ 389.41 ×10⁹/L), Q2 (389.42–534.12 ×10⁹/L), Q3 (534.13–803.77 ×10⁹/L), and Q4 (> 803.78 ×10⁹/L), with an optimal cut-off identified as ≥ 776 ×10⁹/L.

O

Outcome

In-hospital major adverse cardiovascular events (MACE), defined as a composite of all-cause mortality, non-fatal myocardial infarction (reinfarction), and ischemic stroke.composite

Main Result

Odds Ratio: 5.36 (95% CI 2.06–13.98)

p-value: p=0.001

Limitations

Observational, retrospective single-center design limits causal inference
SII was assessed at a single pre-procedural time point without serial measurements
Observational, retrospective design limits causal inference
Single-center design

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Implication

Pre-procedural Systemic Immune-Inflammation Index (SII) is an inexpensive, routine blood count-derived biomarker that strongly and independently predicts in-hospital MACE, greater coronary complexity (SYNTAX score > 27), and lower discharge LVEF in patients undergoing PCI.

Abstract

Background Major adverse cardiovascular events (MACE) continue after percutaneous coronary intervention (PCI) despite advances in revascularisation. Systemic inflammation contributes to atherosclerosis and plaque instability. The Systemic Immune-Inflammation Index (SII) is an inexpensive, easily calculated biomarker derived from routine blood counts that integrates inflammatory and immune pathways. This study evaluated its prognostic value for MACE after PCI. Methods This single-center retrospective observational study included 400 consecutive adults undergoing PCI for stable angina or acute coronary syndromes over 1 year. Pre-procedural complete blood counts were used to calculate SII [(platelet × neutrophil)/lymphocyte]. The primary outcome was in-hospital MACE, comprising all-cause mortality, non-fatal myocardial infarction, and ischemic stroke. Patients were stratified by SII quartiles. ROC analysis and multivariable logistic regression assessed predictive performance and independent associations. Results MACE occurred in 6.8% (n = 27). SII was significantly higher in patients with MACE than without (1127.19 ± 335.99 vs. 599.92 ± 324.55 ×10⁹/L; p < 0.001). High SYNTAX scores (> 27) occurred in 72% of the highest versus 1% of the lowest SII quartile (p < 0.001). Increasing SII was associated with higher troponin positivity and lower discharge left ventricular ejection fraction (p < 0.01). ROC analysis showed excellent predictive ability (AUC 0.886; 95% CI 0.827–0.945), with an optimal cut-off ≥ 776 ×10⁹/L. Multivariable analysis identified SII (adjusted OR 5.36 per quartile increase; p = 0.001) and diabetes mellitus (adjusted OR 4.41; p = 0.024) as independent predictors of MACE. Conclusion Elevated SII independently predicts MACE after PCI and may serve as a simple, cost-effective risk-stratification tool in routine clinical practice.

Discussion

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Cite This Study

Gambhire et al. (2026) conducted a cohort in Stable angina or acute coronary syndromes undergoing percutaneous coronary intervention (PCI) (n=400). Systemic Immune-Inflammation Index (SII) per 1-quartile increase vs. Lower SII quartiles was evaluated on In-hospital major adverse cardiovascular events (MACE: composite of all-cause mortality, non-fatal myocardial infarction, and ischemic stroke) (OR 5.36, 95% CI 2.06-13.98, p=0.001). Each one-quartile increase in the Systemic Immune-Inflammation Index independently increased the odds of in-hospital MACE after PCI (adjusted OR 5.36, 95% CI 2.06–13.98; p=0.001).

synapsesocial.com/papers/6ae92596a8a6b2adf62f5ff5 https://doi.org/10.21203/rs.3.rs-11166407/v1

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Prognostic Value of Systemic Immune-Inflammation Index (SIII) in Predicting Major Adverse Cardiac Events (MACE) in Patients Undergoing Percutaneous Coronary Intervention (PCI): An Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Prognostic Value of Systemic Immune-Inflammation Index (SIII) in Predicting Major Adverse Cardiac Events (MACE) in Patients Undergoing Percutaneous Coronary Intervention (PCI): An Observational Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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