Sex Differences in the Association Between the Systemic Immune‐Inflammation Index and Coronary Lesion Severity in Acute Coronary Syndrome

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Acute coronary syndrome (ACS) (n=130). Intervention: Systemic immune-inflammation index (SII) stratified by sex vs. Female patients with ACS (N=50) vs Male patients with ACS (N=80). Primary outcome: Degree of coronary artery stenosis quantified by the Gensini Score (GS) (B = 0.030 (in males), 95% CI 0.009 to 0.052, p=0.007).

Q: What does this research mean for the field?

The systemic immune-inflammation index is independently associated with coronary stenosis severity in male patients with acute coronary syndrome, but shows no significant association in females. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Ming Hong; Chuntian Wang; Hui Liu; 怀雁; Jiangying Kuang; Huiqiang Chen

doi:10.1002/iid3.70590

November 1, 2026Immunity Inflammation and DiseaseOpen Access

Sex Differences in the Association Between the Systemic Immune‐Inflammation Index and Coronary Lesion Severity in Acute Coronary Syndrome

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Key result

Higher systemic immune-inflammation index is linked to more severe coronary stenosis in males with ACS.

B = 0.030 (in males)
95% CI 0.009 to 0.052
P=0.007
n=130

Why the study?

Elevated systemic immune-inflammation index (SII) correlates with CAD prevalence and severity in ACS, prompting evaluation of the influence of sex on SII and its association with coronary stenosis.

Key Points

To evaluate the influence of sex on the systemic immune-inflammation index (SII) and determine its relationship with coronary stenosis severity in acute coronary syndrome (ACS).
Enrolled 130 patients with ACS who underwent coronary angiography (80 males, 50 females; median age 64 years).
Evaluated coronary stenosis severity using the Gensini Score (GS) and compared clinical and inflammatory markers between sexes.
Conducted multivariate linear regression analyses controlling for age, smoking status, and low-density lipoprotein cholesterol (LDL-C).
Mean SII (618.91 ± 456.67 vs 476.51 ± 267.77, p = 0.048) and GS (67.56 ± 46.04 vs 41.71 ± 34.50, p = 0.001) were significantly higher in male patients than in female patients.
GS positively correlated with SII in males (r = 0.306, p = 0.006), and SII remained independently associated with GS after adjustment (B = 0.030, p = 0.007).
In females, SII did not correlate with GS (r = 0.134, p = 0.353) or demonstrate an independent association (B = 0.027, p = 0.101), whereas LDL-C (B = 11.741, p = 0.003), smoking (B = 39.018, p = 0.016), and age (B = 1.139, p = 0.030) were independently associated.

Study Design

Type

Cross-Sectional (n=130)

Blinding

Single-blind (coronary angiography results independently evaluated by two cardiovascular experts blinded to clinical data)

Multicenter

No

Structured PICO

P

Population

130 consecutive patients (median age 64 years, 38.5% female) admitted with acute coronary syndrome undergoing coronary angiography at a single center in China.

E

Exposure

Systemic immune-inflammation index (SII) measurement, calculated from morning fasting venous blood samples taken prior to coronary angiography via the formula: (platelet count × neutrophil count)/lymphocyte count.

O

Outcome

Degree and severity of coronary artery stenosis quantified by the Gensini Score (GS), independently evaluated from selective coronary angiograms (performed via radial artery access using the Judkins technique) by two cardiovascular experts blinded to clinical data.surrogate

Main Result

Effect estimate: B = 0.030 (in males) (95% CI 0.009 to 0.052)

Absolute Event Rate: 67.56% vs 41.71%

p-value: p=0.007

Limitations

Retrospective, single-center study design with potential selection bias
Small sample size, particularly in the female subgroup (N=50)
Heterogeneity in medications used by enrolled patients prior to admission
SII was calculated only from initial admission values without dynamic follow-up changes
Cross-sectional design lacking long-term tracking data, precluding causal inference
Retrospective and single-center study, introducing the possibility of center selection bias
Small sample size, which may explain the lack of significant differences in female patients
Heterogeneity in the medications used by the enrolled patients may influence the results
Only initial admission results were used to calculate SII, without considering dynamic changes during follow-up
Cross-sectional design lacking long-term tracking data, preventing causal inferences

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Implication

The systemic immune-inflammation index (SII) is independently associated with the severity of coronary artery stenosis in male patients with acute coronary syndrome, but not in female patients, highlighting the need to account for sex differences when using inflammatory biomarkers for risk stratification.

Abstract

BACKGROUND: Elevated systemic immune-inflammation index (SII) correlates with increased coronary artery disease (CAD) prevalence and severity in acute coronary syndrome (ACS). The aim of this study was to evaluate the influence of sex on SII and its association with coronary stenosis in ACS. METHODS: A total of 130 patients with ACS, who had performed coronary angiography, were enrolled. Gensini Score (GS) was used to reflect the degree of coronary stenosis. The association of SII and GS were studied. RESULTS: The mean values of SII and GS were significantly higher (p = 0.048 and 0.001, respectively) in male individuals compared with female counterparts. There was a significant correlation between SII and GS (r = 0.306, p = 0.006) in male participants. However, the positive correlation between SII and GS was not found in female subjects. SII was independently associated with GS (B = 0.030, p = 0.007) after controlling for age, smoking, and low-density lipoprotein cholesterol (LDL-C) in male participants. LDL-C (B = 11.741, p = 0.003), smoking (B = 39.018, p = 0.016) and age (B = 1.139, p = 0.030), but not SII (B = 0.027, p = 0.101) were found to be independently correlated with the degree of coronary stenosis in females. CONCLUSIONS: SII was a associated marker for evaluating the extent of coronary lesions in male subjects with ACS, but not in female counterparts.

Discussion

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Cite This Study

Hong et al. (2026) conducted a cross-sectional in Acute coronary syndrome (ACS) (n=130). Systemic immune-inflammation index (SII) stratified by sex vs. Female patients with ACS (N=50) vs Male patients with ACS (N=80) was evaluated on Degree of coronary artery stenosis quantified by the Gensini Score (GS) (B = 0.030 (in males), 95% CI 0.009 to 0.052, p=0.007). Systemic immune-inflammation index was independently associated with coronary stenosis severity (Gensini Score) in males with ACS (B=0.030, p=0.007), but not in females (B=0.027, p=0.101).

synapsesocial.com/papers/6aee6be671a7594806220cc9 https://doi.org/10.1002/iid3.70590

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Sex Differences in the Association Between the Systemic Immune‐Inflammation Index and Coronary Lesion Severity in Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Sex Differences in the Association Between the Systemic Immune‐Inflammation Index and Coronary Lesion Severity in Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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