Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease

Ya Ling Yang, Cheng Hsueh Wu, Pai Feng Hsu, Su Chan Chen, Shao Sung Huang, Wan Leong Chan, Shing Jong Lin, Chia Yu Chou, Jaw Wen Chen, Ju Pin Pan, Min Ji Charng, Ying Hwa Chen, Tao Cheng Wu, Tse Min Lu, Po Hsun Huang, Hao Min Cheng, Chin Chou Huang, Shih Hsien Sung, Yenn Jiang Lin, Hsin Bang Leu*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

249 Scopus citations


Background: This study examines the predictive value of a novel systemic immune-inflammation index (SII, platelet × neutrophil/lymphocyte ratio) in coronary artery disease (CAD) patients. Methods: A total of 5602 CAD patients who had undergone a percutaneous coronary intervention (PCI) were enrolled. They were divided into two groups by baseline SII score (high SII vs low SII) to analyse the relationship between SII groups and the long-term outcome. The primary outcomes were major cardiovascular events (MACE) which includes nonfatal myocardial infarction (MI), nonfatal stroke and cardiac death. Secondary outcomes included a composite of MACE and hospitalization for congestive heart failure. Results: An optimal SII cut-off point of 694.3 × 109 was identified for MACE in the CAD training cohort (n = 373) and then verified in the second larger CAD cohort (n = 5602). Univariate and multivariate analyses showed that a higher SII score (≥694.3) was independently associated with increased risk of developing cardiac death (HR: 2.02; 95% CI: 1.43-2.86), nonfatal MI (HR: 1.42; 95% CI: 1.09-1.85), nonfatal stroke (HR: 1.96; 95% CI: 1.28-2.99), MACE (HR: 1.65; 95% CI: 1.36-2.01) and total major events (HR: 1.53; 95% CI: 1.32-1.77). In addition, the SII significantly improved risk stratification of MI, cardiac death, heart failure, MACE and total major events than conventional risk factors in CAD patients by the significant increase in the C-index (P <.001) and reclassification risk categories by significant NRI (P <.05) and IDI (P <.05). Conclusions: SII had a better prediction of major cardiovascular events than traditional risk factors in CAD patients after coronary intervention.

Original languageEnglish
Article numbere13230
JournalEuropean Journal of Clinical Investigation
Issue number5
StatePublished - 1 May 2020


  • coronary artery disease
  • inflammation
  • percutaneous coronary intervention


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