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World J Cardiol. Nov 26, 2026; 18(11): 126752
Published online Nov 26, 2026. doi: 10.4330/wjc.126752
Role of novel inflammatory indices in predicting major adverse cardiovascular events following revascularization in chronic limb-threatening ischemia
Abeer A Alwahadneh, Jafar A Alshraideh, Dania A Bani Hani, Mohammad S Abdallah, Kawther Al-Hadidi, Bayan Alshraideh, Khalil Yousef
Abeer A Alwahadneh, Dania A Bani Hani, Faculty of Nursing, Middle East University, Amman 11941, Jordan
Jafar A Alshraideh, Kawther Al-Hadidi, Department of Clinical Nursing, University of Jordan, Amman 11942, Jordan
Mohammad S Abdallah, RMS, Jordan Royal Medical Services, Amman 11942, Jordan
Bayan Alshraideh, Dentistry School, University of Jordan, Amman 11942, Jordan
Khalil Yousef, School of Humanities, Social Sciences and Health, University of Wollongong in Dubai, Dubai 20183, United Arab Emirates
Khalil Yousef, School of Nursing, University of Jordan, Amman 11942, Jordan
Author contributions: Alwahadneh AA and Alshraideh JA conceived the project; Alwahadneh AA, Hani DAB and Abdallah MS were involved in data collection; Abdallah MS, Alshraideh B and Alwahadneh AA were responsible for data organization and curation; Alwahadneh AA, Al-Hadidi K, and Hani DAB performed the statistical analysis; Alshraideh B, Hani DAB and Abdallah MS performed literature search; Alwahadneh AA, Hani DAB and Abdallah MS prepared the first draft; Yousef K and Alshraideh JA critically reviewed the manuscript; Alshraideh JA, Yousef K, Alwahadneh AA approved the final version; Alshraideh JA performed the journal search and submitted the initial version to journal.
AI contribution statement: AI tools, specifically (Grammarly), were used solely for language polishing and formatting assistance. No AI tool was used to generate research data, interpret results, or formulate conclusions. All AI-assisted content was critically reviewed and revised by the authors, who take full responsibility for the accuracy, originality, and integrity of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board at the Ministry of Health (approval No. MOH/REC/2024/284) and Royal Medical Services (approval No. 9/2024). The research was conducted in full accordance with the World Medical Association International Code of Medical Ethics and the Declaration of Helsinki.
Informed consent statement: Participation was voluntary, and verbal informed consent was obtained from all participants before inclusion.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: Data is available with the corresponding author and can be shared on request.
Corresponding author: Jafar A Alshraideh, PhD, Professor, Department of Clinical Nursing, University of Jordan, Amman 11942, Jordan.
jalasad@ju.edu.jo
Received: August 12, 2026
Revised: September 1, 2026
Accepted: October 26, 2026
Published online: November 26, 2026
Processing time: 94 Days and 17.6 Hours
BACKGROUND
Peripheral artery disease (PAD) is a prevalent atherosclerotic condition leading to chronic limb-threatening ischemia (CLTI), which significantly increases the risks of limb loss and cardiovascular events. Despite advancements in revascularization techniques, long-term outcomes remain poor.
AIM
To evaluate the association of pre-procedural inflammatory indices with major adverse cardiovascular events (MACE) following lower-limb revascularization in patients with CLTI, and to assess the predictive performance of clinical models incorporating Systemic Immune-Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammation Response Index (SIIRI).
METHODS
A multicenter prospective observational study was conducted at two tertiary hospitals in Jordan, including 303 adults (≥ 18 years) with CLTI undergoing lower-limb revascularization between June and September 2024. Participants were followed for six months. Baseline demographic and clinical characteristics and pre-procedural inflammatory indices were obtained, and MACE was identified through follow-up and confirmed using medical records. Three multivariable logistic regression models were developed using the same clinical and laboratory covariates, with SII, SIRI, and SIIRI entered separately. The predictive performance of the SIRI-based model was assessed using receiver operating characteristic analysis and 1000 bootstrap resamples for internal validation.
RESULTS
The mean age of participants was 63.6 ± 9.8 years, and 84.5% were male. Overall, MACE occurred in 22.4% of patients. The incidence of MACE increased across Wound, Ischemia, and foot Infection clinical stages, from 12.5% in the low-risk group to 17.7% in the moderate-risk group and 29.0% in the high-risk group (P = 0.038). Surgical revascularization was also more frequent among patients who developed MACE (30.5% vs 18.8%, P = 0.023). In multivariable analysis, SIRI was independently associated with MACE (odds ratio = 1.62, 95%CI: 1.156-2.279; P = 0.005). The SIRI-based model demonstrated strong discrimination, with an apparent area under the curve (AUC) of 0.937 (95%CI: 0.907-0.967), which remained robust after bootstrap internal validation, with an optimism-corrected AUC of 0.920.
CONCLUSION
SIRI was independently associated with MACE in patients with CLTI undergoing lower-limb revascularization and demonstrated strong discriminatory performance when incorporated into a multivariable clinical model. These findings suggest that SIRI may provide additional prognostic information beyond established clinical and laboratory characteristics and may have potential utility for cardiovascular risk stratification in this high-risk population. Further external validation is warranted before clinical implementation.
Core Tip: In this prospective multicenter cohort of patients with chronic limb-threatening ischemia undergoing lower-limb revascularization, Systemic Inflammatory Response Index (SIRI) was independently associated with six-month major adverse cardiovascular events and improved the discriminatory performance of a multivariable clinical model. Bootstrap internal validation demonstrated that the model retained strong discriminatory ability after correction for optimism. These findings highlight the potential of SIRI to refine cardiovascular risk assessment in this high-risk population, while external validation in independent cohorts remains essential before clinical implementation.
