Background Pro‐inflammatory pathways play an important role in the follow‐ups of patients with intracardiac defibrillators (ICDs) for heart failure (HF) reduced with ejection fraction (HFrEF). A newly defined index ‐ the systemic immune‐inflammation index (SII)—has recently been reported to have prognostic value in patients with cardiovascular disease. This study's aim is to evaluate the SII value regarding its association with long‐term mortality and appropriate ICD therapy during a 10‐year follow‐up. Methods This retrospective study included 1011 patients with ICD for HFrEF. The SII was calculated as the neutrophil—to—lymphocyte ratio × total platelet count in the peripheral blood. The study population was divided into two groups according to the SII's optimal cut‐off value to predict long‐term mortality. The long‐term prognostic impact of SII on these patients was evaluated regarding mortality and appropriate ICD therapy. Results The patients with a higher SII (≥1119) had significantly higher long‐term mortality and appropriate ICD therapy rates. After adjustment for all confounding factors, the long‐term mortality rate was 5.1 for a higher SII. (95% CI: 2.9–8.1). The long‐term appropriate ICD therapy rate was 2.0 for a higher SII (95% CI: 1.4–3.0). Conclusion SII may be an independent predictive marker for both long‐term mortality and appropriate ICD therapy in patients with HFrEF.

The Naples score is a new prognostic score developed according to inflammatory and nutritional status and frequently evaluated in cancer patients. The present study aimed to evaluate using the Naples prognostic score (NPS) to predict the development of decreased left ventricular ejection fraction (LVEF) after acute ST-segment elevation myocardial infarction (STEMI). The study has a multicenter and retrospective design and included 2280 patients with STEMI who underwent primary percutaneous coronary intervention (pPCI) between 2017 and 2022. All participants were divided into 2 groups according to their NPS. The relationship between these 2 groups and LVEF was evaluated. The low-Naples risk group (Group-1) included 799 patients, and the high-Naples risk group (Group-2) had 1481 patients. Hospital mortality, shock, and no-reflow rates were found to be higher in Group 2 compared with Group 1 ( P < .001, P = .032, P = .004). The NPS was significantly inversely associated with discharge LVEF (B coefficient: −1.51, 95% CI-2.26; −.76, P = .001). NPS, a simple and easily calculated risk score, may help identify high-risk STEMI patients. To the best of our knowledge, the present study is the first to demonstrate the relationship between low LVEF and NPS in patients with STEMI.

Background The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and proinflammatory condition. We sought to investigate the value of PNI in predicting long‐term mortality among HFrEF patients with ICD. Methods Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Patients were divided into the quartiles according to PNI values. Differences between the groups were analyzed by the log‐rank test. A forward Cox proportional regression model was used for multivariable analysis. Results One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and nonischemic in 77.3% and 22.7% of patients, respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% (hazard ratio [HR] 1.76, 95% confidence interval [95% CI] [0.92‐3.38]) in Q2, 10.2% (HR 1.88, 95% CI 0.99‐3.58) in Q3, and 39.6% (HR 8.12, 95% CI 4.65‐14.17) in Q4. The same trend was consistent in the age‐ and sex‐adjusted, comorbidities‐adjusted, and covariates‐adjusted models. Conclusion Among patients who were implanted with ICD secondary to HFrEF, lower PNI value predicted all‐cause mortality during long‐term follow‐up. This is the first study demonstrating the value of PNI in this population.

Background: Patients with heart failure with reduced ejection fraction (HFrEF) who received implantable cardiac defibrillator (ICD) still remain at high risk due to pump failure and prevalent comorbid conditions. The primary aim of this research was to evaluate the predictive value of C-reactive protein-to-albumin ratio (CAR) for allcause mortality among patients with HFrEF despite ICD implantation. Materials and methods: Those who were implanted ICD for HFrEF in our institution between 2009 and 2019 were included. Data were extracted from hospital's database. CAR was calculated as ratio of C-reactive protein (CRP) to serum albumin concentration. Patients were grouped into tertiles in accordance with CAR at the time of the implantation. During follow-up duration of 38 [17-77] months, survival times of tertiles were compared by using Kaplan-Meier survival method. Forward Cox proportional regression model was used for multivariable analysis. Results: Thousand and eleven patients constituted the study population. Ischaemic cardiomyopathy was the primary diagnosis in 92.3%, and ICD was implanted for the primary prevention among 33.9% of patients. Of those, 14.5% died after the discharge. Patients in tertile 3 (T3) had higher risk of mortality (4.2% vs 11.0% vs 28.5%) compared with those in other tertiles. Multivariable analysis revealed that when patients in T1 were considered as the reference, both those in T2 and those in T3 had independently higher risk of all-cause mortality. This finding was consistent in the unadjusted and adjusted multivariable models. Conclusion: Among patients with HFrEF and ICD, elevated CAR increased the risk of all-cause mortality at long term. K E Y W O R D SC-reactive protein-to-albumin ratio, heart failure with reduced ejection fraction, implantable cardiac defibrillator, mortality 2 of 7 | ÇINIER Et al. How to cite this article: Çinier G, Hayıroğlu Mİ, Kolak Z, et al. The value of C-reactive protein-to-albumin ratio in predicting long-term mortality among HFrEF patients with implantable cardiac defibrillators.

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