Evaluation of the relationship of lesion seriousness with systemic immune inflammation index in acute coronary syndrome patients according to the new paradigm

Ischemic heart disease ranks first among the causes of death worldwide. Although the leading causes of death differed between countries with socioeconomic differences in the past, today this situation seems to be equalized. Despite the developing technology and new technical approaches, it is noteworthy that ischemic heart disease still ranks first among the causes of death. (2) Acute coronary syndromes, which are the most important members of the ischemic heart diseases group, are classified as STEMI (ST segment elevation myocardial infarction), NSTEMI (non-ST segment elevation myocardial infarction) / Unstable Angina. (15) According to current guidelines, electrocardiogram criteria are used as a predictor of acute coronary occlusion in patients presenting with acute coronary syndrome. Early reperfusion treatment decision is made based on whether there is ST segment elevation in the ECG. It has emerged that this classification based on ECG has some inadequacies, especially with the increase in angiography practice. According to some studies, acute coronary occlusion was found in approximately 25-30% of patients diagnosed with NSTEMI. These patients receive invasive treatment late because of this handicap in diagnosis. It is obvious that the classical electrocardiographic approach is insufficient in the diagnosis of patients with total coronary occlusion, the most important group of patients with acute coronary syndrome. It is natural that this electrocardiographic diagnostic approach, which has survived from the thrombolytic era, does not fully reflect the anatomical substrate in acute coronary syndromes, because angiography was not yet used for diagnosis at that time. There is a need for a new acute coronary syndrome diagnosis approach in the light of the developing angiographic technique. As a result of studies conducted in recent years, two definitions have been made as Occlusive myocardial infarction (OMI) and Non-occlusive myocardial infarction (NOMI). OMI is defined purely anatomically as total coronary occlusion or near-total coronary occlusion with insufficient epicardial collateral vessels. NOMI is defined as acute myocardial infarction without evidence of OMI. (20) (21) (22) (23) The marker called the Systemic Immune Inflammation Index (SII) and formulated as Neutrophil * Platelet / Lymphocyte is used to predict postprocedure recurrence in patients who have undergone percutaneous coronary intervention in terms of cardiology. Recently, SII, which has been used as a simultaneous indicator of inflammation and immune status, has been reported to be associated with poor results, especially in cancer patients. It is thought that this new marker can be used to predict the development and severity of coronary artery disease. (47) (48) The patients in our study were classified twice. It was first grouped as NSTEMI, STEMI and Normal according to the classical classification, and then as NOMI, OMI and Normal according to the new classification. Systemic Immune Inflammation Index averages were calculated in each patient group and compared with each other. When the upper limit of the SII averages recommended to be used in predicting the severity of coronary artery disease was accepted as '694.3', it was determined that the high values in the groups showed a direct correlation with the severity of coronary artery disease. When the SII averages of both the classical classification and the groups in the new classification were compared, a statistically significant difference was found. Based on these results, when the mean of SII measurements of the electrocardiogram-based classification, which is still used in the definition of acute coronary syndromes according to current guidelines, and the anatomical-based classification, which we describe as new, were compared, they were found to be similar in terms of determining the severity of coronary artery disease. Considering the limitations in the diagnostic power of the classical classification, it is thought that the anatomical-based classification may be a good alternative. Since this new classification is basically made after coronary angiography, it was concluded that SII at the first contact with patients may also be important in determining the severity of coronary artery disease and in managing the treatment plan.