The Pan-Immune-Inflammation Value (PIV) predicts major adverse cardiovascular events in elderly patients undergoing percutaneous coronary intervention: a real-world study

Purpose The Pan-Immune-Inflammation Value (PIV), a novel inflammatory marker primarily studied in cancer, remains underinvestigated in elderly PCI patients. This study evaluates PIV's prognostic value for risk stratification and personalized treatment in this population. Patients and methods: In our study, we enrolled 1426 elderly PCI patients (age ≥ 75 years) between 2019 and 2023. Patients were divided into low- and high-PIV groups based on the optimal cut-off value determined by receiver operating characteristic (ROC) curve analysis. The primary endpoint was the incidence of major adverse cardiovascular events (MACE), comprising cardiac death, recurrent myocardial infarction, and target vessel revascularization. Secondary endpoints included the individual components of MACE. Cox regression and ROC analyses were employed to evaluate the independent prognostic value of PIV. Results Patients in the high-PIV group had a more adverse clinical profile at baseline. During a median follow-up of 362 days, the high-PIV group experienced a significantly higher incidence of MACE (10.8% vs. 5.1%, P < 0.001), cardiac death (7.1% vs. 2.8%, P < 0.001), and all-cause mortality (10.8% vs. 4.5%, P < 0.001). Multivariable Cox regression confirmed PIV as an independent predictor of MACE after adjusting for confounders (Model 3: HR 1.572, 95% CI 1.040,2.377, P = 0.032). ROC analysis showed that PIV had superior predictive ability for MACE (AUC = 0.641) compared to models combining PIV with age ≥ 80 years. Conclusion PIV serves as a simple, potent, and independent prognostic biomarker for MACE in elderly patients following PCI. Its integration into clinical risk stratification could help identify high-risk patients who may benefit from more intensive management.