Miaomiao Li,1,2,* Mengchun Li,3,* Zhenwei Wang,4 Yongbo Zhang1,2 

1Department of Cardiology, Chest Hospital of Zhengzhou University, Zhengzhou, 450008, People’s Republic of China; 2Department of Cardiology, Henan Province Chest Hospital, Zhengzhou, 450008, People’s Republic of China; 3Department of Pediatrics, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, People’s Republic of China; 4Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Zhenwei Wang; Yongbo Zhang, Email 1229445463@qq.com; zhangyongbozyb@163.com

Background: The combined effect of systemic immune-inflammation index (SII) and aortic valve calcification (AVC) on the risk of major adverse cardiovascular events (MACE) in patients with coronary heart disease (CHD) remains unclear. This study aimed to investigate their combined association with MACE in CHD.
Methods: This retrospective cohort study included 846 CHD patients. SII was calculated as platelet count × neutrophil count / lymphocyte count, and AVC status was determined by echocardiography. Patients were divided into four groups based on median SII and AVC presence: Low SII + AVC (-), High SII + AVC (-), Low SII + AVC (+), and High SII + AVC (+). Cox regression, subgroup and sensitivity analyses assessed the association between SII + AVC and MACE.
Results: Multivariate Cox regression revealed that, compared to the Low SII + AVC (-), MACE risk increased 6.542-fold in the High SII + AVC (+) group and 1.605-fold in the High SII + AVC (-) group (P < 0.05). Subgroup analysis indicated that, compared to the Low SII + AVC (-), MACE risk was significantly elevated in the High SII + AVC (-) group for patients over 60, both genders, with hypertension, hyperlipidemia, or without diabetes (P < 0.05). In the Low SII + AVC (+) group, MACE risk was elevated only in males (P < 0.05). The High SII + AVC (+) group had increased MACE risk in all subgroups except those with diabetes (P < 0.05). After excluding patients with estimated glomerular filtration rate < 60 mL/min/1.73m², the high SII + AVC (+) group remained significantly associated with increased MACE risk (P = 0.001), as did the High SII + AVC (-) group (P = 0.031).
Conclusion: The combination of SII and AVC is significantly associated with MACE risk in patients with CHD.

Keywords: systemic immune-inflammation index, aortic valve calcification, coronary heart disease, major adverse cardiovascular events, combined effect