Endothelial Activation and Stress Index (EASIX) as a Predictor of No‐Reflow in Patients Undergoing Saphenous Vein Graft Percutaneous Coronary Intervention

BACKGROUND: No-reflow phenomenon (NRP) is a significant complication of percutaneous coronary intervention (PCI) in saphenous vein grafts (SVGs). The Endothelial Activation and Stress Index (EASIX), derived from LDH, creatinine, and platelet count, is a marker of endothelial dysfunction and inflammation. AIMS: To assess the association between EASIX and NRP in patients undergoing SVG PCI. METHODS: A total of 343 patients with non-ST elevation myocardial infarction who underwent SVG PCI between March 2020 and June 2025 were retrospectively enrolled. Patients were categorized according to the development of NRP. Multivariate logistic regression identified independent predictors, and the discriminative performance of EASIX was assessed using receiver operating characteristic (ROC) curves. RESULTS: NRP occurred in 71 patients (20.7%). Patients with NRP had higher EASIX scores (1.61 ± 1.43 vs. 0.73 ± 0.36, p < 0.001), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII). EASIX (OR: 3.151, p = 0.001), NLR, and reduced left ventricular ejection fraction were independent predictors of NRP. ROC analysis indicated that EASIX predicted NRP with an AUC of 0.779 (95% CI: 0.711-0.847, p < 0.001). The optimal EASIX cut-off was 0.79, with 70% sensitivity and 68% specificity. CONCLUSION: EASIX, a simple and easily calculated score, is independently associated with no-reflow in patients undergoing SVG PCI.