In the current issue of Advances in Interventional Cardiology, a critical commentary was made on our article “The relationship between advanced lung cancer inflammation index and high SYNTAX score in patients with non-ST-elevation myocardial infarction” [1].
Firstly, a larger number of patients with a SYNTAX score ≥ 33 could have made our study’s statistical analysis more powerful and robust. As mentioned in the limitations of our study, our study carries a potential risk of bias, as in other studies designed as retrospective and single-center. A considerable number of patient groups were excluded from our study. For all these reasons, we agree with the emphasis on the need for larger, multicenter clinical studies.
Secondly, we think that the mechanism behind the relationship between the advanced lung cancer inflammation index (ALI) and coronary artery disease (CAD) severity may be related to the components included in this index. In the ALI index, neutrophil-to-lymphocyte ratio (NLR) and serum albumin are included as inflammatory factors, while serum albumin and body mass index (BMI) are included as nutritional factors. A detailed discussion on NLR and serum albumin has been made in our study. Our current study found that patients with a low ALI presented with lower BMI and serum albumin, which has been shown in previous studies [2]. Our study reports an inverse relationship between BMI and SYNTAX score, known as the “obesity paradox”, but revealing the relationship between BMI and NLR, albumin and other inflammatory parameters could allow us to analyze the effects of these parameters on each other. Moreover, it could help to elucidate the individual and cumulative effects of ALI parameters on atherosclerosis progression.
Finally, we did not compare ALI with previously independently established tools that have been associated with CAD severity. It could have helped us understand the clinical value of ALI. Additionally, there are many clinical features and patient-related factors that influence the decision of coronary artery bypass grafting, percutaneous coronary intervention and medical follow-up therapeutic options in acute coronary syndrome patients. Our study was not designed to assess this. Future studies may explore the clinical value of ALI and its position in clinical decision-making.
