The Clinical Significance and Prognostic Value of Inflammatory Hematological Indices in Young Patients with Coronary Artery Disease

Objective: This study primarily investigates the relationship between inflammatory hematological indices [neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune inflammation index (SII), system inflammation response index (SIRI), and pan-immune inflammation value (PIV)] and acute coronary syndrome (ACS) in young patients, with secondary objectives to explore their association with coronary artery disease (CAD) severity and long-term prognosis. Methods: This observational study enrolled 986 CAD patients (aged 18– 35 years) undergoing coronary angiography at Beijing Anzhen Hospital between January 2013 and December 2021. Participants were divided into ACS and non-ACS groups and further stratified by Gensini score into mild, moderate, and severe lesion groups. Patients were followed for a median of 8 years for major adverse cardiovascular events (MACE). Statistical analyses included Spearman correlation, ROC curves, and logistic regression to evaluate the relationships between inflammatory indices and ACS, coronary severity, and long-term outcomes. Results: The prevalence of ACS progressively increased with higher quartiles of NLR, PLR, MLR, SII, SIRI, and PIV ( P for trend < 0.05). All indices were independently associated with ACS risk (P < 0.05), with ROC analysis indicating that SIRI (AUC = 0.720) and PIV (AUC = 0.721) had better predictive performance for ACS compared to other indices. NLR, MLR, and SIRI showed significant positive correlations with Gensini score and were independent predictors of coronary lesion severity ( P < 0.05). For long-term prognosis, smoking, familial hypercholesterolemia, higher Gensini score, and lower PLR were independent predictors of MACE, whereas other indices showed limited prognostic value. Conclusion: In young patients with CAD, SIRI and PIV are valuable for ACS prediction, and several indices correlate with lesion severity. However, their limited long-term prognostic utility suggests distinct pathological mechanisms may govern disease progression in this unique population. Keywords: young patients, coronary artery disease, inflammatory hematological indices, major adverse cardiovascular events, coronary severity