{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T20:16:25Z","timestamp":1778530585256,"version":"3.51.4"},"reference-count":24,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T00:00:00Z","timestamp":1778198400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>Background: This study investigated the role of lymphocyte-based inflammatory indices (LBIIs) in predicting severe coronary artery disease (CAD) in patients undergoing coronary angiography (CAG) for unstable angina pectoris (USAP). Methods: Records of patients who underwent CAG between January 2023 and December 2024 were retrospectively reviewed. The patients were divided into two groups based on coronary artery stenosis severity: non-severe CAD (&lt;70% stenosis) and severe CAD (\u226570% stenosis). Demographic data, risk factors, and complete blood count parameters were recorded. Six LBIIs were calculated: the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune\u2013Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Systemic Immune\u2013Inflammatory Response Index (SIIRI). Diagnostic performance was evaluated using logistic regression and ROC curve analyses. Results: Out of 505 patients, 234 (46.3%) had severe CAD. Among the six LBIIs, only the SII differed significantly between groups in univariate analysis and showed moderate discrimination in the ROC analysis (AUC 0.71; 95% CI 0.661\u20130.762; p &lt; 0.001; sensitivity 76.2%; specificity 56.1%). However, the SII was not an independent predictor in the multivariate analysis. Conclusions: LBIIs (NLR, MLR, PLR, SII, SIRI, and SIIRI) do not provide a clinically significant and independent contribution to predicting severe CAD in USAP patients undergoing CAG. Although the SII performed moderately well in the univariate analysis, it lost independence in the multivariate analysis and is thus not suitable for use as a standalone marker in clinical decision-making.<\/jats:p>","DOI":"10.3390\/jcdd13050200","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:35:43Z","timestamp":1778528143000},"page":"200","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Limited Utility of Lymphocyte-Based Inflammatory Indices in Troponin-Negative Unstable Angina Pectoris"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7504-7637","authenticated-orcid":false,"given":"\u015e\u00fckriye","family":"Uslu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Antalya Training and Research Hospital, Health Science University, Antalya 07100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9540-5075","authenticated-orcid":false,"given":"G\u00fcls\u00fcm Meral","family":"Y\u0131lmaz \u00d6ztekin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Antalya Training and Research Hospital, Health Science University, Antalya 07100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmet","family":"Gen\u00e7","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Antalya Training and Research Hospital, Health Science University, Antalya 07100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9404-7306","authenticated-orcid":false,"given":"Ekin Can","family":"\u00c7elik","sequence":"additional","affiliation":[{"name":"Department of Cardivascular Surgery, Antalya Training and Research Hospital, Health Science University, Antalya 07100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"\u015eakir","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Antalya Training and Research Hospital, Health Science University, Antalya 07100, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,8]]},"reference":[{"key":"ref_1","first-page":"9","article-title":"Exploring the Landscape of Coronary Artery Disease: A Comprehensive Review","volume":"1","author":"Mir","year":"2024","journal-title":"Am. J. Biomed. Pharm."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2135","DOI":"10.1016\/j.jacc.2024.11.009","article-title":"2025 ACC\/AHA\/ACEP\/NAEMSP\/SCAI guideline for the management of patients with acute coronary syndromes: A report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"85","author":"Rao","year":"2025","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"7","DOI":"10.5334\/gh.1286","article-title":"Unstable Angina: Risk Stratification for Significant Coronary Artery Disease in the Era of High-Sensitivity Cardiac Troponin","volume":"19","author":"Paiva","year":"2024","journal-title":"Glob. Heart"},{"key":"ref_4","first-page":"1445","article-title":"Incidence and 1-Year Prognostic of Unstable Angina After High-Sensitivity Troponin Assessment","volume":"105","author":"Jouen","year":"2025","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1340","DOI":"10.1002\/iid3.1340","article-title":"Prognosis impact of multiple novel lymphocyte-based inflammatory indices in patients with initially diagnosed coronary artery disease","volume":"12","author":"Gao","year":"2024","journal-title":"Immun. Inflamm. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Li, Q., Ma, X., Shao, Q., Yang, Z., Wang, Y., Gao, F., Zhou, Y., Yang, L., and Wang, Z. (2022). Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients. Front. Cardiovasc. Med., 9.","DOI":"10.3389\/fcvm.2022.811790"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e14100","DOI":"10.1111\/eci.14100","article-title":"Prognostic value of systemic immune-inflammation index in CAD patients: Systematic review and meta-analyses","volume":"54","author":"Zhao","year":"2024","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"7057","DOI":"10.2147\/JIR.S481515","article-title":"Association Between the Aggregate Index of Systemic Inflammation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Study","volume":"17","author":"Jiang","year":"2024","journal-title":"J. Inflamm. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1097\/MCA.0000000000001454","article-title":"Systemic immune inflammatory response index (SIIRI) in acute myocardial infarction","volume":"36","author":"Muheeb","year":"2025","journal-title":"Coron. Artery Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"312","DOI":"10.5455\/medarh.2017.71.312-315","article-title":"Neutrophil-to-lymphocyte Ratio and Its Relation with Markers of Inflammation and Myocardial Necrosis in Patients with Acute Coronary Syndrome","volume":"71","author":"Tahto","year":"2017","journal-title":"Med. Arch."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1177\/00033197241263399","article-title":"Association between systemic Immune-inflammation index and adverse outcomes in patients with Acute Coronary Syndrome: A Meta-analysis","volume":"76","author":"Wang","year":"2024","journal-title":"Angiology"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.avsg.2024.08.009","article-title":"The role of inflammation biomarkers in carotid artery stenosis procedures","volume":"110","author":"Scalise","year":"2025","journal-title":"Ann. Vasc. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e012322","DOI":"10.1161\/JAHA.119.012322","article-title":"Clinical and Laboratory Predictors for Plaque Erosion in Patients with Acute Coronary Syndromes","volume":"8","author":"Yamamoto","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3911","DOI":"10.1093\/eurheartj\/ehad334","article-title":"Culprit plaque morphology determines inflammatory risk and clinical outcomes in acute coronary syndrome","volume":"44","author":"Gerhardt","year":"2023","journal-title":"Eur. Heart J."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1016\/j.jcmg.2021.10.014","article-title":"Plaque Rupture, Compared with Plaque Erosion, Is Associated with a Higher Level of Pancoronary Inflammation","volume":"15","author":"Nakajima","year":"2022","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Buonpane, A., De Caterina, A.R., Trimarchi, G., Pizzino, F., Ciardetti, M., Coceani, M.A., Esposito, A., Pastormerlo, L.E., Monteleone, A., and Clemente, A. (2025). Uncovering Plaque Erosion: A Distinct Pathway in Acute Coronary Syndromes and a Gateway to Personalized Therapy. J. Clin. Med., 14.","DOI":"10.3390\/jcm14155456"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Buonpane, A., Trimarchi, G., Ciardetti, M., Coceani, M.A., Alagna, G., Benedetti, G., Berti, S., And\u00f2, G., Burzotta, F., and De Caterina, A.R. (2024). Optical Coherence Tomography in Myocardial Infarction Management: Enhancing Precision in Percutaneous Coronary Intervention. J. Clin. Med., 13.","DOI":"10.3390\/jcm13195791"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Cheng, W.H., and Wang, Y. (2025). Inflammatory Pathways in Coronary Artery Disease: Which Ones to Target for Secondary Prevention?. Cells, 14.","DOI":"10.20944\/preprints202501.0241.v1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1161\/01.ATV.20.5.1262","article-title":"Lessons from sudden coronary death: A comprehensive morphological classification scheme for atherosclerotic lesions","volume":"20","author":"Virmani","year":"2000","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1852","DOI":"10.1161\/CIRCRESAHA.114.302721","article-title":"Mechanisms of plaque formation and rupture","volume":"114","author":"Bentzon","year":"2014","journal-title":"Circ. Res."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Luo, X., Lv, Y., Bai, X., Qi, J., Weng, X., Liu, S., Bao, X., Jia, H., and Yu, B. (2021). Plaque Erosion: A Distinctive Pathological Mechanism of Acute Coronary Syndrome. Front. Cardiovasc. Med., 8.","DOI":"10.3389\/fcvm.2021.711453"},{"key":"ref_22","first-page":"105","article-title":"Pathogenesis of plaque erosion","volume":"36","author":"Quinones","year":"2025","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1038\/s41569-021-00542-3","article-title":"Plaque erosion and acute coronary syndromes: Phenotype, molecular characteristics and future directions","volume":"18","author":"Fahed","year":"2021","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1080\/00015385.2021.1963564","article-title":"Neutrophil-to-lymphocyte ratio predicts coronary artery lesion severity and long-term cardiovascular mortality in patients with unstable angina pectoris","volume":"77","author":"Li","year":"2022","journal-title":"Acta Cardiol."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/5\/200\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T19:59:38Z","timestamp":1778529578000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/13\/5\/200"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,8]]},"references-count":24,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcdd13050200"],"URL":"https:\/\/doi.org\/10.3390\/jcdd13050200","relation":{},"ISSN":["2308-3425"],"issn-type":[{"value":"2308-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,8]]}}}