International journal of cardiology · 2026
C-reactive protein-albumin-lymphocyte index and coronary microvascular dysfunction after primary percutaneous coronary intervention: The mediating role of insulin resistance.
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Wang Wei, Qiu Hang, Wang Jian, Jiang Hao
Аннотация
BACKGROUND: The C-reactive protein-albumin-lymphocyte (CALLY) index integrates systemic inflammation, nutritional status, and immune function. We investigated its association with angiography-derived microvascular resistance (AMR)-defined coronary microvascular dysfunction (CMD) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), and performed an exploratory statistical mediation analysis involving estimated glucose disposal rate (eGDR).
METHODS: This retrospective, single-center observational study included 456 consecutive patients with STEMI undergoing primary PCI. AMR-defined CMD was prespecified as AMR ≥250 mmHg·s/m. Multivariable logistic regression, restricted cubic spline (RCS), and prespecified subgroup analyses were performed. Sensitivity and exploratory mediation analyses were also performed.
RESULTS: AMR-defined CMD was present in 228 patients (50.0%). In Model 3, each doubling of CALLY was associated with lower odds of AMR-defined CMD (OR, 0.87; 95% CI, 0.80-0.94; P < 0.001). Compared with Q1, Q3 and Q4 were associated with 44% (OR, 0.56; 95% CI, 0.32-0.97; P = 0.037) and 52% (OR, 0.48; 95% CI, 0.28-0.84; P = 0.010) lower odds, respectively (P for trend = 0.018). RCS analysis showed an overall association (P = 0.001) without evidence of nonlinearity (P = 0.310). No significant subgroup interactions were observed. Exploratory mediation analysis estimated that eGDR statistically accounted for 15.47% of the observed association.
CONCLUSIONS: Higher CALLY values were inversely associated with AMR-defined CMD after primary PCI for STEMI. eGDR may account for part of this association. CALLY may serve as an auxiliary marker for AMR-defined CMD risk stratification, pending prospective multicenter validation.
METHODS: This retrospective, single-center observational study included 456 consecutive patients with STEMI undergoing primary PCI. AMR-defined CMD was prespecified as AMR ≥250 mmHg·s/m. Multivariable logistic regression, restricted cubic spline (RCS), and prespecified subgroup analyses were performed. Sensitivity and exploratory mediation analyses were also performed.
RESULTS: AMR-defined CMD was present in 228 patients (50.0%). In Model 3, each doubling of CALLY was associated with lower odds of AMR-defined CMD (OR, 0.87; 95% CI, 0.80-0.94; P < 0.001). Compared with Q1, Q3 and Q4 were associated with 44% (OR, 0.56; 95% CI, 0.32-0.97; P = 0.037) and 52% (OR, 0.48; 95% CI, 0.28-0.84; P = 0.010) lower odds, respectively (P for trend = 0.018). RCS analysis showed an overall association (P = 0.001) without evidence of nonlinearity (P = 0.310). No significant subgroup interactions were observed. Exploratory mediation analysis estimated that eGDR statistically accounted for 15.47% of the observed association.
CONCLUSIONS: Higher CALLY values were inversely associated with AMR-defined CMD after primary PCI for STEMI. eGDR may account for part of this association. CALLY may serve as an auxiliary marker for AMR-defined CMD risk stratification, pending prospective multicenter validation.