Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://cr.elmerpub.com

Original Article

Volume 17, Number 5, October 2026, pages 534-544

Diagnostic Value of Systemic Inflammatory Indices in Myocardial İnfarction With Non-Obstructive Coronary Arteries: Comparison With Obstructive Myocardial Infarction and Non-Critical Coronary Artery Disease

↓ Figure 1. Flow diagram of patient selection and study group allocation. MINOCA: myocardial infarction with non-obstructive coronary arteries; MI: myocardial infarction; CAD: coronary artery disease.

↓ Figure 2. Receiver operating characteristic (ROC) curve analysis of neutrophil count, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and left ventricular ejection fraction (LVEF) for differentiation between MINOCA and obstructive myocardial infarction (group 1 vs group 2). MINOCA: myocardial infarction with non-obstructive coronary arteries.

↓ Figure 3. Receiver operating characteristic (ROC) curve analysis of neutrophil count, systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and left ventricular ejection fraction (LVEF) for differentiation between MINOCA and non-critical coronary artery disease (group 1 vs group 3). MINOCA: myocardial infarction with non-obstructive coronary arteries.

↓ **Table 1.** Baseline Demographic and Clinical Characteristics of the Study Population
Variable	MINOCA (n = 67)	Obstructive MI (n = 222)	Non-critical CAD (n = 207)	P value
Values are expressed as mean ± standard deviation or number (percentage). CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries.
Age (years)	56.75 ± 16.09	66.32 ± 10.93	58.76 ± 10.39	< 0.001
Male sex, n (%)	37 (55.2)	157 (70.7)	111 (53.6)	< 0.001
Diabetes mellitus, n (%)	18 (26.9)	107 (48.2)	64 (30.9)	< 0.001
Hypertension, n (%)	21 (31.3)	107 (48.2)	61 (29.5)	< 0.001
Smoking, n (%)	27 (40.3)	79 (35.6)	75 (36.2)	0.631

↓ Table 1. Baseline Demographic and Clinical Characteristics of the Study Population

Variable

MINOCA (n = 67)

Obstructive MI (n = 222)

Non-critical CAD (n = 207)

P value

Values are expressed as mean ± standard deviation or number (percentage). CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries.

Age (years)

56.75 ± 16.09

66.32 ± 10.93

58.76 ± 10.39

< 0.001

Male sex, n (%)

37 (55.2)

157 (70.7)

111 (53.6)

< 0.001

Diabetes mellitus, n (%)

18 (26.9)

107 (48.2)

64 (30.9)

< 0.001

Hypertension, n (%)

21 (31.3)

107 (48.2)

61 (29.5)

< 0.001

Smoking, n (%)

27 (40.3)

79 (35.6)

75 (36.2)

0.631

↓ **Table 2.** Echocardiographic Parameters of the Study Population
Variable	MINOCA (n = 67)	Obstructive MI (n = 222)	Non-critical CAD (n = 207)	P value
Values are expressed as mean ± standard deviation. LVEF: left ventricular ejection fraction; SPAP: systolic pulmonary artery pressure; CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries.
LVEF (%)	53.81 ± 8.71	48.69 ± 9.06	58.77 ± 5.17	< 0.001
SPAP (mm Hg)	31.27 ± 8.81	31.89 ± 6.75	28.55 ± 6.30	< 0.001

↓ Table 2. Echocardiographic Parameters of the Study Population

Variable

MINOCA (n = 67)

Obstructive MI (n = 222)

Non-critical CAD (n = 207)

P value

Values are expressed as mean ± standard deviation. LVEF: left ventricular ejection fraction; SPAP: systolic pulmonary artery pressure; CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries.

LVEF (%)

53.81 ± 8.71

48.69 ± 9.06

58.77 ± 5.17

< 0.001

SPAP (mm Hg)

31.27 ± 8.81

31.89 ± 6.75

28.55 ± 6.30

< 0.001

↓ **Table 3.** Laboratory Parameters and Systemic Inflammatory Indices of the Study Population
Variable	MINOCA (n = 67)	Obstructive MI (n = 222)	Non-critical CAD (n = 207)	P value
Values are expressed as mean ± standard deviation. WBC: white blood cell count; LDL: low-density lipoprotein; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; CRP: C-reactive protein; CAR: CRP-to-albumin ratio; CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries; proBNP: pro–B-type natriuretic peptide.
Neutrophil	5.7 ± 2.14	6.65 ± 2.46	4.57 ± 1.48	< 0.001
Lymphocyte	2.26 ± 0.92	2.08 ± 0.91	2.33 ± 0.77	0.009
Platelet	242.27 ± 71.13	231.92 ± 65.12	238.05 ± 60.63	0.418
Monocyte	0.69 ± 0.25	0.72 ± 0.27	0.64 ± 0.20	0.005
Hemoglobin	13.14 ± 1.72	12.99 ± 1.97	13.39 ± 1.79	0.080
WBC	8.88 ± 2.45	9.61 ± 2.65	7.80 ± 1.96	< 0.001
Creatinine	0.91 ± 0.23	1.07 ± 0.32	0.88 ± 0.20	< 0.001
Glucose	116.53 ± 42.53	156.61 ± 73.10	115.86 ± 39.30	< 0.001
Albumin	4.01 ± 0.35	3.97 ± 0.41	4.30 ± 0.37	< 0.001
LDL	111.91 ± 35.31	123.99 ± 38.08	113.46 ± 35.58	0.004
SII	756.12 ± 660.39	931.90 ± 739.43	505.64 ± 245.85	< 0.001
NLR	3.17 ± 2.54	4.01 ± 2.87	2.17 ± 1.06	< 0.001
PLR	125.89 ± 67.75	133.00 ± 69.80	111.69 ± 41.20	0.001
MLR	0.35 ± 0.24	0.39 ± 0.22	0.30 ± 0.11	< 0.001
CRP	10.11 ± 15.17	17.54 ± 26.98	5.25 ± 8.24	< 0.001
CAR	2.52 ± 3.74	4.70 ± 7.66	1.26 ± 2.00	< 0.001
ProBNP	1,201.55 ± 1,904.01	2,940.03 ± 4,953.32	164.78 ± 268.23	< 0.001

↓ Table 3. Laboratory Parameters and Systemic Inflammatory Indices of the Study Population

Variable

MINOCA (n = 67)

Obstructive MI (n = 222)

Non-critical CAD (n = 207)

P value

Values are expressed as mean ± standard deviation. WBC: white blood cell count; LDL: low-density lipoprotein; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; MLR: monocyte-to-lymphocyte ratio; CRP: C-reactive protein; CAR: CRP-to-albumin ratio; CAD: coronary artery disease; MI: myocardial infarction; MINOCA: myocardial infarction with non-obstructive coronary arteries; proBNP: pro–B-type natriuretic peptide.

Neutrophil

5.7 ± 2.14

6.65 ± 2.46

4.57 ± 1.48

< 0.001

Lymphocyte

2.26 ± 0.92

2.08 ± 0.91

2.33 ± 0.77

0.009

Platelet

242.27 ± 71.13

231.92 ± 65.12

238.05 ± 60.63

0.418

Monocyte

0.69 ± 0.25

0.72 ± 0.27

0.64 ± 0.20

0.005

Hemoglobin

13.14 ± 1.72

12.99 ± 1.97

13.39 ± 1.79

0.080

WBC

8.88 ± 2.45

9.61 ± 2.65

7.80 ± 1.96

< 0.001

Creatinine

0.91 ± 0.23

1.07 ± 0.32

0.88 ± 0.20

< 0.001

Glucose

116.53 ± 42.53

156.61 ± 73.10

115.86 ± 39.30

< 0.001

Albumin

4.01 ± 0.35

3.97 ± 0.41

4.30 ± 0.37

< 0.001

LDL

111.91 ± 35.31

123.99 ± 38.08

113.46 ± 35.58

0.004

SII

756.12 ± 660.39

931.90 ± 739.43

505.64 ± 245.85

< 0.001

NLR

3.17 ± 2.54

4.01 ± 2.87

2.17 ± 1.06

< 0.001

PLR

125.89 ± 67.75

133.00 ± 69.80

111.69 ± 41.20

0.001

MLR

0.35 ± 0.24

0.39 ± 0.22

0.30 ± 0.11

< 0.001

CRP

10.11 ± 15.17

17.54 ± 26.98

5.25 ± 8.24

< 0.001

CAR

2.52 ± 3.74

4.70 ± 7.66

1.26 ± 2.00

< 0.001

ProBNP

1,201.55 ± 1,904.01

2,940.03 ± 4,953.32

164.78 ± 268.23

< 0.001

↓ **Table 4.** ROC Analysis Results for Differentiation of MINOCA and Obstructive Myocardial Infarction
Variable	Cut-off	AUC	Sensitivity	Specificity	PPV	NPV	P value
AUC: area under the curve; PPV: positive predictive value; NPV: negative predictive value; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; LVEF: left ventricular ejection fraction; ROC: receiver operating characteristic; MINOCA: myocardial infarction with non-obstructive coronary arteries.
Neutrophil	≥ 6.7	0.622	0.423	0.776	0.862	0.289	0.002
SII	≥ 796.44	0.589	0.451	0.731	0.848	0.287	0.022
NLR	≥ 3.23	0.611	0.491	0.702	0.845	0.294	0.004
LVEF	≤ 50	0.678	0.586	0.716	0.873	0.343	< 0.001

↓ Table 4. ROC Analysis Results for Differentiation of MINOCA and Obstructive Myocardial Infarction

Variable

Cut-off

AUC

Sensitivity

Specificity

PPV

NPV

P value

AUC: area under the curve; PPV: positive predictive value; NPV: negative predictive value; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; LVEF: left ventricular ejection fraction; ROC: receiver operating characteristic; MINOCA: myocardial infarction with non-obstructive coronary arteries.

Neutrophil

≥ 6.7

0.622

0.423

0.776

0.862

0.289

0.002

SII

≥ 796.44

0.589

0.451

0.731

0.848

0.287

0.022

NLR

≥ 3.23

0.611

0.491

0.702

0.845

0.294

0.004

LVEF

≤ 50

0.678

0.586

0.716

0.873

0.343

< 0.001

↓ **Table 5.** ROC Analysis Results for Differentiation of MINOCA and Non-Critical Coronary Artery Disease
Variable	Cut-off	AUC	Sensitivity	Specificity	PPV	NPV	P value
AUC: area under the curve; PPV: positive predictive value; NPV: negative predictive value; SII: systemic immune-inflammation index; NLR: neutrophil-to-lymphocyte ratio; LVEF: left ventricular ejection fraction; ROC: receiver operating characteristic; MINOCA: myocardial infarction with non-obstructive coronary arteries.
Neutrophil	≥ 5.4	0.665	0.522	0.749	0.402	0.829	< 0.001
SII	≥ 534.29	0.630	0.582	0.667	0.361	0.831	0.002
NLR	≥ 2.19	0.634	0.627	0.618	0.347	0.837	0.001
LVEF	≤ 55	0.697	0.567	0.792	0.469	0.850	< 0.001

↓ Table 5. ROC Analysis Results for Differentiation of MINOCA and Non-Critical Coronary Artery Disease

Variable

Cut-off

AUC

Sensitivity

Specificity

PPV

NPV

P value

Neutrophil

≥ 5.4

0.665

0.522

0.749

0.402

0.829

< 0.001

SII

≥ 534.29

0.630

0.582

0.667

0.361

0.831

0.002

NLR

≥ 2.19

0.634

0.627

0.618

0.347

0.837

0.001

LVEF

≤ 55

0.697

0.567

0.792

0.469

0.850

< 0.001