Low advanced lung cancer inflammation index significantly predicted for cardiovascular events in patients with chronic total occlusion after PCI: a prospective, single-center and observational study

Abstract Objective The advanced lung cancer inflammation index (ALI), calculated as body mass index (BMI) × albumin/neutrophil-to-lymphocyte ratio (NLR), has been proven as a prognostic indicator in oncology and cardiovascular diseases (CVD). In the present study, we aimed to investigate the relationship between ALI and major adverse cardiovascular events (MACEs) in CTO patients who underwent successful PCI. Methods A total of 527 CTO patients after successful PCI were consecutively included in this study. Patients were divided into the MACE group and the control group according to the occurrence of MACEs. The primary endpoint was MACEs, including all-cause death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR). The Cox proportional hazards models were performed to investigate the predictors for the presence of MACEs. The receiver operating characteristic (ROC) curves were employed to explore the cut-off value and the predictive value of ALI for the occurrence of MACEs in CTO-PCI patients. Results During a median time of three years of follow-up, 74 MACEs (14.04%) were recorded. Patients with MACEs tended to have a lower ALI level. The multivariable Cox proportional hazard regression showed that ALI was an independent predictor for the occurrence of MACEs in CTO-PCI patients. When the patients were divided into three groups according to the tertiles of the ALI, we discovered that patients in the low ALI tertile had a 2.825-fold increased risk of MACEs compared with the high ALI tertile. When ALI was less than 276.81, the specificity was 0.633 and the sensitivity was 0.610 for the prediction of MACEs in CTO-PCI patients ( P < 0.001). In addition, ALI had a superior performance in the prediction of MACEs than albumin and BMI, but not for neutrophil-to-lymphocyte ratio (NLR). Conclusion Low ALI is independently associated with increased cardiovascular risk in CTO-PCI patients. ALI, a cost-effective inflammatory–nutritional marker, may improve the risk stratification and provide a promising therapeutic target for CTO-PCI patients.