Neutrophil-to-HDL-C Ratio and Anatomically Significant Multivessel Disease Across Acute Coronary Syndrome Phenotypes

Abstract

Objective The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is an emerging inflammatory-lipid biomarker. Whether NHR is associated with anatomically significant multivessel disease (MVD) across different acute coronary syndrome (ACS) phenotypes remains unclear. Methods We analyzed 421 consecutive ACS patients [268 with non-ST-segment elevation myocardial infarction (NSTEMI) and 153 with ST-segment elevation myocardial infarction (STEMI)] who underwent coronary angiography. Anatomically significant MVD was defined as ≥70% stenosis in at least two major epicardial coronary arteries, or ≥70% stenosis in one epicardial coronary artery in addition to ≥50% stenosis of the left main coronary artery. Receiver operating characteristic analysis and multivariable logistic regression were performed. Results Among NSTEMI patients, NHR predicted anatomically significant MVD with an area under the curve (AUC) of 0.694 [95% confidence interval (CI): 0.630-0.757, p<0.001], using an optimal cut-off value of 0.1365 (78.0% sensitivity, 59.4% specificity). After multivariable adjustment, NHR remained independently associated with MVD (odds ratio: 5.870, 95% CI: 1.402-11.859, p<0.001). Among STEMI patients, NHR did not demonstrate discriminatory ability (AUC=0.481, p=0.690). In the overall ACS population, the NHR demonstrated modest discriminatory performance (AUC=0.615, p<0.001). Conclusions NHR was associated with anatomically significant MVD mainly in patients with NSTEMI, whereas no meaningful discriminatory value was observed in patients with STEMI. This phenotype-specific finding suggests that NHR may better reflect the presence of MVD in NSTEMI than serve as a uniform marker across all ACS presentations.