Turk Kardiyol Dern Ars. Ahead of Print: TKDA-94076 | DOI: 10.5543/tkda.2026.94076
Inflammatory and Combined Indices Outperform Metabolic Indices in Predicting One-Year MACE in NSTEMI with Type 2 Diabetes
Metin Karayakalı1, Kayıhan Karaman1, Osman Demir2, Gülşen Genç Tapar1, Arif Arısoy3, Gökhan Cabri1, Volkan Yılmaz1, Emrah Özdemir4, Samet Yılmaz5, Ataç Çelik111Department of Cardiology, Tokat Gaziosmanpaşa University Hospital, Tokat, Türkiye
2Department of Biostatistics, Tokat Gaziosmanpaşa University, Tokat, Türkiye
3Department of Cardiology, Tokat Medical Park Private Hospital, Tokat, Türkiye
4Department of Cardiology, Biruni University Hospital, İstanbul, Türkiye
5Department of Cardiology, Adana Dr. Turgut Noyan Practice and Research Center, Baskent University, Adana, Türkiye
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.
Methods: 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.
Keywords: Biomarkers, diabetes mellitus, inflammation, non-ST-elevation myocardial infarction, prognostic value
Corresponding Author: Metin Karayakalı
Manuscript Language: English