Key result
Inflammatory and combined indices outperformed metabolic indices for 1-year MACE, with CTI (OR 2.446; 95% CI 1.746-3.427; P<0.001) and SIRI (AUC 0.764 vs TyG 0.638; P<0.001) independently predictive.
Why the study?
Patients with NSTEMI and T2DM carry a high residual cardiovascular risk that conventional risk scores inadequately capture, prompting an evaluation of the prognostic value of composite metabolic, inflammatory, combined, and nutritional blood-based indices.
Do composite inflammatory and combined blood-based indices outperform metabolic indices in predicting one-year MACE in patients with NSTEMI and type 2 diabetes mellitus?
Cohort (n=557)
No
Do composite inflammatory and combined blood-based indices outperform metabolic indices in predicting one-year MACE in patients with NSTEMI and type 2 diabetes mellitus?
Routine admission blood-based combined and inflammatory indices (CTI, SIRI) and nutritional index (PNI) independently predict 1-year MACE and outperform pure metabolic surrogates in high-risk NSTEMI patients with T2DM.
Answers are grounded in this paper and cite their sources.
These indices may refine 1-year MACE prediction in NSTEMI with T2DM; leaves open prospective validation before clinical adoption.
OBJECTIVE: Patients with non-ST-elevation myocardial infarction (NSTEMI) and type 2 diabetes mellitus (T2DM) carry a high residual cardiovascular risk that is inadequately captured by conventional risk scores. We aimed to compare the prognostic value of ten composite blood-based indices from metabolic, inflammatory, combined, and nutritional categories for one-year major adverse cardiovascular events (MACE) in this population. METHOD: In this single-center retrospective cohort study, 557 consecutive NSTEMI patients with T2DM who underwent coronary angiography were enrolled. Ten indices were calculated from admission blood samples: TyG, AIP, and METS-IR as metabolic indices; SIRI, PIV, and NLR as inflammatory indices; CTI and CAR as combined indices; and PNI and HALP as nutritional indices. Discrimination was assessed by receiver operating characteristic (ROC) analysis with DeLong comparison, independent predictors were identified by multivariate logistic regression, and survival separation was evaluated by Kaplan-Meier analysis. RESULTS: One-year MACE occurred in 118 patients (21.2%). Inflammatory indices outperformed metabolic indices in ROC analysis (SIRI AUC 0.764 vs. TyG 0.638; P < 0.001). In multivariate regression, CTI (OR 2.446; 95% CI 1.746-3.427; P < 0.001), SIRI (OR 1.242; 95% CI 1.088-1.417; P = 0.001), and PNI (OR 0.918; 95% CI 0.884-0.954; P < 0.001) remained independent predictors alongside left ventricular ejection fraction (LVEF), SYNTAX score, and estimated glomerular filtration rate (eGFR). Pure metabolic indices lost significance after CTI entered the model. SIRI yielded the widest Kaplan-Meier survival separation (29.5 percentage points; P < 0.001). CTI remained significant across all subgroups, whereas SIRI lost independence in patients with reduced ejection fraction. CONCLUSION: In NSTEMI patients with T2DM, CTI, SIRI, and PNI independently predict one-year MACE based on routine admission blood tests. Inflammatory and combined indices outperform pure metabolic surrogates, supporting a shift toward multidimensional risk stratification in this high-risk population.
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Karayakalı et al. (2026) conducted a cohort in Non-ST-elevation myocardial infarction (NSTEMI) with type 2 diabetes mellitus (T2DM) (n=557). Composite inflammatory and combined indices (CTI, CAR, SIRI, PIV, NLR) vs. Metabolic (TyG, AIP, METS-IR) and nutritional (PNI, HALP) indices was evaluated on One-year major adverse cardiovascular events (MACE) (OR 2.446, 95% CI 1.746-3.427, p=<0.001). Inflammatory and combined indices outperformed metabolic indices for 1-year MACE, with CTI (OR 2.446; 95% CI 1.746-3.427; P<0.001) and SIRI (AUC 0.764 vs TyG 0.638; P<0.001) independently predictive.
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