Prognostic value of hemoglobin-to-serum creatinine ratio in patients with coronary artery disease and reduced kidney function following percutaneous coronary intervention
Abstract
Objective This investigation sought to assess the prognostic significance of the hemoglobin-to-serum creatinine (Hb/SCr) ratio for long-term survival among patients with coexisting coronary artery disease (CAD) and reduced kidney function after percutaneous coronary intervention (PCI). Methods This retrospective study encompassed 2,310 patients who underwent PCI and had concomitant CAD and reduced kidney function. The cohort median Hb/SCr value of 1.60 was used as a pragmatic reference threshold to classify patients into low (<1.60) and high (≥1.60) Hb/SCr groups. The predictive significance of the Hb/SCr ratio regarding cardiac-cause mortality (CCM) and all-cause mortality (ACM) over a follow-up period of up to 60 months was evaluated employing Kaplan–Meier analysis and multivariable Cox proportional hazards models. Results During 60 months of follow-up, 56 cardiac-cause deaths (2.4%) and 87 all-cause deaths (3.8%) occurred. Kaplan–Meier analysis showed significantly higher cumulative mortality in the low Hb/SCr group for both CCM (log-rank P = 0.002263) and ACM (log-rank P = 0.002349). The Hb/SCr ratio showed modest discrimination for CCM (AUC 0.663, 95% CI 0.585–0.742) and ACM (AUC 0.614, 95% CI 0.548–0.680). Compared with Hb/SCr < 1.60, Hb/SCr ≥ 1.60 was associated with lower adjusted risks of CCM (HR 0.49, 95% CI 0.27–0.90; P = 0.021) and ACM (HR 0.59, 95% CI 0.37–0.94; P = 0.028). Similar associations were observed when the ratio was analysed as a continuous variable (CCM: HR 0.28, 95% CI 0.14–0.57; ACM: HR 0.42, 95% CI 0.23–0.77). Conclusion A lower Hb/SCr ratio independently predicts increased long-term risks of CCM and ACM in patients with CAD and reduced kidney function after PCI. Given its modest discriminative ability, this readily available ratio may serve as a complementary marker for risk stratification rather than a standalone predictive tool, potentially helping to identify patients who warrant closer post-procedural surveillance.