# Elevated inflammatory index and future risk of stroke in patients with coronary heart disease: a multicenter prospective cohort study

## TL;DR

This study finds that higher levels of three inflammatory markers are linked to a greater risk of stroke in patients with coronary heart disease, with one marker showing the best predictive value.

## Contribution

The study identifies the aggregate index of systemic inflammation (AISI) as the most effective inflammatory marker for predicting stroke risk in coronary heart disease patients.

## Key findings

- All three inflammatory markers (SIRI, SII, AISI) were significantly associated with increased stroke risk in CHD patients.
- AISI showed superior predictive performance compared to SIRI and SII for stroke risk.
- Stroke risk rose substantially when AISI, SII, and SIRI exceeded 117, 450, and 0.95, respectively.

## Abstract

Previous studies have consistently shown that patients with coronary heart disease (CHD) face an elevated risk of stroke, with inflammation likely playing a significant contributing role. Building on this evidence, the present study aims to investigate the associations between three emerging inflammatory markers and the risk of stroke in patients with CHD, as well as to identify which marker offers the greatest clinical predictive value.

This study involved 5,289 patients with CHD from three clinical centers. COX regression analysis was conducted to examine the relationships between three inflammatory markers—systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and aggregate index of systemic inflammation (AISI)—and the risk of stroke in patients with CHD, and Kaplan–Meier (KM) curves were generated to visualize stroke incidence across different marker levels. In addition, restricted cubic splines (RCS) were applied to assess potential dose–response relationships. Finally, receiver operating characteristic curves and C-statistics were used to evaluate the predictive performance of the three inflammatory markers for stroke risk.

During the 4.82-year median follow-up period, a total of 785 participants experienced stroke events. The COX regression analysis showed that all three inflammatory markers were significantly associated with an increased risk of stroke in patients with CHD. Consistently, the KM curves indicated that patients with higher levels of inflammation experienced a markedly higher incidence of stroke compared with those in the low-inflammation group. Furthermore, the RCS analysis revealed that when AISI, SII, and SIRI exceeded 117, 450, and 0.95, respectively, the risk of stroke rose substantially. Finally, the comparative analysis showed that AISI demonstrates significantly better predictive performance.

These three inflammatory indicators are closely linked to an increased risk of stroke in patients with CHD. In addition, comparative analysis indicates that the inflammatory index represented by AISI has superior predictive performance. Consequently, AISI may offer a feasible tool for early monitoring and risk assessment of stroke in patients with CHD.