Nutritional Risk Index and HALP Score Across the Angiographic Extent of Coronary Artery Involvement in NSTEMI

Abstract

Objective: This study aimed to comprehensively investigate whether admission nutritional–inflammatory composite indices reflect the angiographic extent of coronary artery involvement in patients with non-ST-segment elevation myocardial infarction (NSTEMI), utilizing an ordinal modeling framework that preserves the hierarchical spectrum of 1-vessel disease (1VD), 2-vessel disease (2VD), and 3-vessel disease (3VD). Methods: A retrospective, single-center analysis was performed in 430 consecutive patients with NSTEMI who underwent index coronary angiography and percutaneous coronary intervention without a prior history of coronary artery disease. Participants were categorized by the extent of obstructive disease into 1VD (n = 199), 2VD (n = 159), and 3VD (n = 72) groups. The hemoglobin-albumin-lymphocyte-platelet (HALP) score, Nutritional Risk Index (NRI), atherogenic index of plasma (AIP), and triglyceride–glucose (TyG) index were examined. Results: Both NRI and HALP score exhibited a stepwise decline from 1VD to 3VD (NRI medians: 102.30, 98.05, and 96.25, P < .001; HALP medians: 4.81, 4.08, and 3.88, P < .001). By contrast, AIP and TyG index showed no statistically significant variation across vessel groups (P = .36 and P = .19, respectively). In adjusted ordinal regression, both NRI (odds ratio [OR], 0.90; 95% CI, 0.87–0.92; P < .001) and HALP score (OR, 0.79; 95% CI, 0.72–0.86; P < .001) remained independently associated with vessel-group category. Conclusions: Lower NRI and HALP values were independently associated with a greater extent of angiographic coronary artery involvement after multivariable adjustment, although NRI demonstrated greater incremental discriminative performance. Neither AIP nor the TyG index showed a significant association with coronary involvement.