Title : Inflammatory indexes, mortality, and hemodynamic changes after percutaneous closure of post-MI ventricular septal rupture

Objectives: The novel inflammatory complex index is associated with the prognosis of numerous cardiovascular diseases. This study aimed to evaluate the prognostic value of inflammatory indexes—neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and platelet-to-lymphocyte ratio (PLR)—for in-hospital mortality and postoperative hemodynamic alterations after percutaneous closure of post-myocardial infarction (MI) ventricular septal rupture (VSR).

Methods: This single-center retrospective study consecutively enrolled 133 patients who successfully underwent percutaneous closure of post-MI VSR. Blood samples at admission were used to calculate NLR, SII, SIRI, and PLR. Pulmonary artery systolic pressure change (ΔPASP) was measured via transthoracic echocardiography. Elastic net regression and Boruta algorithm were used for confounder selection. Restricted cubic spline (RCS) and logistic regression analyzed the associations between inflammatory indexes and mortality. Generalized additive models (GAM) explored the nonlinear relationships between inflammatory indexes and ΔPASP.

Results: The results showed that in-hospital mortality occurred in 37 (27.8%) patients. After adjusting for confounders, NLR and Log2SII independently predicted mortality. GAM revealed an inverted U-shaped relationship between Log2SII/Log2SIRI and postoperative PASP reduction. ROC curve analysis indicated Log2SII had demonstrated a moderately higher predictive accuracy than PLR (AUC = 0.697 vs. 0.616, p = 0.010).

Conclusions: NLR and Log2SII are robust predictors of in-hospital mortality after percutaneous closure of post-MI VSR, while Log2SII and Log2SIRI exhibit threshold effects on hemodynamic alterations, reflecting inflammation’s dual role in prognosis. These findings underscore the clinical utility of inflammatory indexes for perioperative risk assessment, necessitating multicenter validation and mechanistic exploration.

Keyword: inflammatory index; ventricular septal rupture; prognosis; in-hospital mortality; hemodynamics

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