ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Atherosclerosis and Vascular Medicine
Association between systemic inflammation indices and carotid plaques in Acute coronary syndrome
Yantai Yuhuangding Hospital, Yantai, China
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Abstract
Background Ischemic stroke is a leading cause of death and disability. Identifying patients with carotid atherosclerosis at high risk is clinically important. Acute coronary syndrome (ACS) is a manifestation of systemic atherosclerosis, in which inflammation plays a key role in plaque progression and destabilization. However, the relationship between blood cell–derived systemic inflammation indices and carotid plaque burden in patients with ACS remains unclear. Methods This retrospective study included 7,178 patients with ACS. According to carotid ultrasound, patients were classified into carotid plaque and non-plaque groups. Systemic inflammation indices, including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte-plus-lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), systemic immune-inflammatory index (SII), aggregate index of systemic inflammation (AISI), and platelet-to-lymphocyte ratio (PLR), were calculated from routine blood tests. Multivariable logistic regression, restricted cubic spline models, and subgroup analyses were used to evaluate their associations with carotid plaques. Results Patients with carotid plaques had significantly higher NLR, MLR, NMLR, SIRI, SII, AISI, and PLR. After full adjustment, MLR, SIRI, and AISI showed significant nonlinear associations with carotid plaques, with inflection points of 0.26, 0.9, and 205, respectively. Compared with the lowest quartile, the highest quartile was associated with increased odds of carotid plaques for MLR (OR 1.453), SIRI (OR 1.409), and AISI (OR 1.379). Subgroup analyses showed that these associations were mainly observed in women and in non-diabetic patients. In patients with hypertension, MLR, SIRI, and AISI remained positively associated with carotid plaques. Conclusion MLR, SIRI, and AISI are independently associated with carotid plaques in patients with ACS, particularly in women and non-diabetic individuals, and may serve as potential markers for ischemic stroke risk stratification in this population.
Summary
Keywords
Acute Coronary Syndrome, carotid plaque, Inflammation, MLR, PLR, SII
Received
08 December 2025
Accepted
16 February 2026
Copyright
© 2026 Ren, Wang, Zhong and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Lin Zhong; Chunxiao Wang
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