Association between hemoglobin-to–HDL cholesterol ratio and long-term major adverse cardiovascular events in STEMI patients undergoing PCI
Residual cardiovascular risk remains high in patients with ST-segment elevation myocardial infarction (STEMI) despite successful primary percutaneous coronary intervention (PCI). Hemoglobin and high-density lipoprotein cholesterol (HDL-C) are routinely measured biomarkers reflecting oxygen delivery and cardiometabolic status, respectively. Whether the hemoglobin-to–HDL cholesterol ratio (Hb/HDL ratio) is associated with prognosis in patients with STEMI undergoing PCI remains unknown. We evaluated the association between the Hb/HDL ratio and long-term major adverse cardiovascular events (MACE) in patients with STEMI. A total of 462 consecutive patients with STEMI undergoing primary PCI were included (median follow-up, 30 months). The primary endpoint was a composite of MACE. The Hb/HDL ratio was modeled continuously (per 1-SD increment) and categorically (by tertiles). Time-to-event analyses were performed using Kaplan–Meier analysis and multivariable Cox proportional hazards regression. Dose–response relationships and exploratory incremental prognostic performance were evaluated using restricted cubic spline analysis and time-dependent ROC, IDI, and continuous NRI. During 30 months of follow-up, 118 patients (25.5%) developed MACE. Kaplan–Meier curves showed significantly lower MACE-free survival in the lowest Hb/HDL tertile(log-rank P = 0.002). In multivariable-adjusted Cox models, each 1-SD increment in the Hb/HDL ratio was associated with a 26% lower risk of MACE (HR 0.74, 95% CI 0.59–0.93; P = 0.009). This association remained unchanged after additional adjustment for peak cardiac troponin I (HR 0.74, 95% CI 0.59–0.92; P = 0.008). Compared with the lowest tertile, both the second and third tertiles were associated with reduced risks (HR 0.56 and 0.61, respectively; P for trend = 0.023). RCS analysis showed an inverse association between the Hb/HDL ratio and MACE, with no evidence of nonlinearity (P for overall association = 0.017; P for nonlinearity = 0.232). Results were consistent across most subgroups, except for a significant interaction with apelin levels (P for interaction = 0.033). Higher Hb/HDL ratio was independently and linearly associated with a lower long-term risk of MACE in STEMI patients undergoing PCI. Given its routine availability in clinical practice, the Hb/HDL ratio may serve as a simple adjunctive marker for long-term risk stratification following primary PCI.