The Global Immune-Nutrition Inflammation Index for Predicting Coronary Slow Flow Phenomenon in Patients with Angina and No Obstructive Coronary Arteries

Jiang Guo,1 Zhi-zhen Xiang,1 Dan-dan Ma2 1Department of Cardiovascular Medicine, Longquan People’s Hospital Affiliated to Lishui University, Lishui, People’s Republic of China; 2Department of Intensive Care Unit, Shenzhen Luohu Hospital Group Luohu People’s Hospital (The Third Affiliated Hospital of Shenzhen University), Shenzhen, People’s Republic of ChinaCorrespondence: Dan-dan Ma, Email [email protected]: Chronic inflammatory responses are involved in the initiation and development of the coronary slow flow phenomenon (CSFP). However, as a newly developed immuno-nutritional inflammation indicator, the global immune-nutrition inflammation index (GINI) has not been well elaborated for predicting CSFP in patients with angina and no obstructive coronary arteries (ANOCA).Methods: A total of 1422 individuals with ANOCA were consecutively included in this study, of whom 93 developed CSFP (CSFP group). We selected 186 (1:2 matched) age- and sex-matched patients with ANOCA and angiographically proven normal coronary blood flow as the controls (the control group). Multivariate logistic regression analysis was used to investigate predictors of CSFP in patients with ANOCA. The optimal cutoff values for GINI were calculated.Results: In total, 93 patients developed CSFP, including 29% (27) in one vessel, 28% (26) in two vessels, and 43% (40) in three vessels. Patients with CSFP had an elevated CRP level, white blood cell (WBC) count, neutrophil count, GINI, fasting blood glucose (FBG) level, and a lower lymphocyte count (P< 0.05). Multivariate logistic analysis showed that the GINI and FBG levels were independent predictors of CSFP in patients with ANOCA. Moreover, we found that the more vessels affected by CSFP, the higher the GINI level. The receiver operating characteristic (ROC) showed that GINI had a better predictive value than indicators alone. When the GINI AISI was > 84.1, the sensitivity and specificity were 88.2% and 58.7%, respectively [The Area Under the ROC curve (AUC): 0.774; 95% CI: 0.721– 0.827; P < 0.001].Conclusion: Elevated GINI is a reliable predictor of CSFP in patients with ANOCA. Moreover, GINI had a superior predictive value compared to the indicators alone. As a newly developed inflammatory indicator, GINI can be used for further risk stratification of patients with ANOCA.Keywords: global immune-nutrition inflammation index, coronary slow flow phenomenon, angina no obstructive coronary arteries, predictors