Neutrophil to High-Density Lipoprotein Cholesterol Ratio Predicts Left Ventricular Remodeling and MACE After PCI in Patients with Acute ST-Segment Elevation Myocardial Infarction

Jian Lin Chen ^1* Anbang Liu ² Hong Lin ³ Dan Zhang ⁴ 鑫赫 Zhang ² Weihong Xu ² Yan Zheng ⁵ Guohai Su ^4*

• ¹ School of Clinical Medicine, Shandong Second Medical University, Weifang, China
• ² Shandong Academy of Medical Sciences (SDAMS), Jinan, Shandong Province, China
• ³ Fujian Medical University, Fuzhou, Fujian Province, China
• ⁴ Jinan Central Hospital, Jinan, Shandong Province, China
• ⁵ Department of Cardiovascular Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, Shandong Province, China

The neutrophil to high-density lipoprotein cholesterol ratio (NHR) has been proposed as a potential marker for predicting cardiovascular events. However, its prognostic role following percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) remains unclear. This study aimed to evaluate the predictive value of NHR for left ventricular remodeling (LVR) and long-term outcomes in STEMI patients post-PCI. Methods: This retrospective study included 299 STEMI patients who underwent PCI and were followed for 24 months post-procedure. Echocardiography was performed upon admission and at 6 months post-MI. LVR was defined as an increase in left ventricular diastolic volume(LVEDV) of at least 20% from baseline. Based on their VR status, patients were divided into LVR(n=81)and non-LVR(n=218)groups.A weighted logistic regression model was used to study the correlation between NHR and LVR. Weighted Cox proportional risk models were used to estimate hazard ratios and 95% confidence intervals for major adverse cardiovascular events(MACE).And the NHR was analyzed using receiver operating characteristic (ROC) curves to predict the occurrence of postoperative LVR and MACE in STEMI patients. Restricted cubic splineanalysis was used to explore the linear or non-linear relationship between NHR and LVR or MACE. Cox survival analysis was used to assess the relationship between NHR, LVR and survival time. Results: Among the 299 STEMI patients enrolled in the study, LVR was observed in 81 patients after 24 months of follow-up. The LVR group had significantly higher NHR levels compared to the non-LVR group (8.19 ± 1.95 vs. 6.23 ± 1.91, P < 0.001). After adjusting for potential confounders, a significant positive correlation was found between NHR and LVR. Each standard deviation increase in NHR was associated with a 43% higher risk of MACE (HR: 1.43, 95% CI: 1.25-1.64, P < 0.001).ROC curve analysis demonstrated that NHR could predict both LVR (AUC: 0.762) and MACE (AUC: 0.722). An NHR cut-off value of >8.13 was significantly linked to an increased risk of MACE (HR: 4.30, 95% CI: 2.41-7.69). Conclusions NHR is an independent predictor of LVR and MACE after PCI in STEMI patients. Monitoring NHR may aid in identifying high-risk patients early, facilitating individualized treatment.