Association of C-reactive protein-albumin-lymphocyte index and coronary artery calcification on major adverse cardiovascular events of dialysis patients with acute coronary syndrome

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Abstract
Background and objective: Inflammation, immune dysfunction, malnutrition and severe coronary artery calcification (CAC) are critical cardiovascular risk factors in patients on dialysis. However, their combined prognostic value in dialysis patients with acute coronary syndrome (ACS) remains unclear. This study aims to evaluate the associations of the C-reactive protein-albumin-lymphocyte (CALLY) index (integrating inflammatory, immune and nutritional parameters) and angiographically detected CAC status with major adverse cardiovascular events (MACE) in this population. Methods: This multicenter retrospective cohort study finally included 681 dialysis patients with ACS between January 2015 and June 2021. Patients were categorized into groups based on the median of the CALLY index and the severity of angiographic CAC. The endpoint was the occurrence of MACE, defined as a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke. Results: During a median follow-up of 23.54 months, 329 cases of MACE occurred. Multivariable Cox regression models demonstrated that a higher CALLY index was independently associated with a reduced risk of MACE [high vs. low CALLY index: hazard ratio (HR) = 0.521; 95% confidence interval (CI): 0.412-0.659], whereas moderate-to-severe CAC significantly increased the risk of MACE [HR = 1.267; 95% CI: 1.008-1.592]. When stratified by both parameters, patients with a higher CALLY index and no-or-mild CAC exhibited the lowest cumulative incidence of MACE [HR = 0.420; 95% CI: 0.302-0.585). Notably, the combined assessment of the CALLY index and angiographically detected CAC status significantly improved the predictive accuracy beyond the Global Registry of Acute Coronary Events (GRACE) score or baseline risk model. Conclusion: In dialysis patients with ACS, a lower CALLY index and moderate-to-severe CAC were both independent risk factors of MACE. Integrating the categorical classification of the CALLY index level and angiographic CAC status significantly improved prognostic performance, providing additional information for cardiovascular risk stratification in this high-risk population.

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