Abstract
OBJECTIVES: This study evaluates the prognostic value of the systemic inflammation response index (SIRI) in myocardial infarction (MI) patients. METHODS: PubMed, Embase, Web of Science, and Cochrane were used to search literature through January 2026, focusing on mortality and major adverse cardiovascular events (MACE) as outcomes. Risk ratios (RR) and 95% confidence intervals (CI) were used for data synthesis. Sensitivity and subgroup analyses assessed result stability and identified potential sources of heterogeneity. For results with publication bias, the trim-and-fill method was used to assess its impact on the results. RESULTS: Thirteen studies involving 16,054 MI patients were included. Higher SIRI linked with an increased risk of mortality (RR: 2.73; 95% CI: 1.82, 4.10; P < 0.00001) and MACE (RR: 1.54; 95% CI: 1.37, 1.73; P < 0.00001) in MI patients. Sensitivity analysis confirmed the stability of SIRI as a predictor for both mortality and MACE. Subgroup analysis indicated that the SIRI cut-off value was the primary contributor to the significant heterogeneity observed in mortality and MACE. CONCLUSIONS: SIRI can effectively predict mortality and MACE in MI patients, identifying those at high risk early for targeted intervention. Larger, multicenter, prospective cohort studies are required to further evaluate its prognostic value in MI patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-026-05633-y.