Meng He, Zhou Xiujun, Li Lushan, Liu Yuanying, Liu Yujie, Zhang Ying
Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China.
Department of Cardiology, Chest Hospital, Tianjin University, Tianjin, People's Republic of China.
Int J Gen Med. 2025 Mar 7;18:1383-1391. doi: 10.2147/IJGM.S502386. eCollection 2025.
Severe in-stent restenosis (ISR) following the implantation of drug-eluting stent (DES) can lead to recurrent angina pectoris or even acute myocardial infarction, thereby necessitating target lesion revascularization (TLR). Prior studies have confirmed the correlation between the monocyte to high-density lipoprotein cholesterol ratio (MHR) and ISR after DES implantation. The potential of MHR to predict TLR following DES implantation remains an area of ongoing research and may have significant clinical implications.
A retrospective analysis was conducted on a consecutive series of 474 patients undergoing DES implantation and follow-up coronary angiography between December 1, 2014 and December 1, 2022. The patients were categorized into two distinct groups according to their exposure to TLR. To assess the predictive performance of the MHR with respect to TLR, we utilized multivariate logistic regression analysis and receiver operating characteristic (ROC) curve analysis.
The study revealed a significant elevation in the MHR value within the TLR group compared to the non-TLR group (12.34 vs 8.97; P < 0.001). MHR was identified as an independent predictor of TLR (Odds Ratio [OR] = 1.162; 95% Confidence Interval [CI]: 1.102-1.225). The area under the curve (AUC) was found to be 0.712 (95% CI: 0.664-0.759). When the MHR exceeded 10.98, the specificity for predicting TLR was 75.8%, and the sensitivity was 58.0%. When the MHR was incorporated into the predictive model comprising established risk factors, there was a notable improvement in the AUC, from 0.689 to 0.749 (P < 0.001). Additionally, there was a significant categorical net reclassification improvement (NRI) of 0.183 (P < 0.001) and an integrated discrimination improvement (IDI) of 0.074 (P < 0.001).
The MHR functions as a predictor for TLR subsequent to DES implantation. Incorporating MHR into the predictive model improves the model's accuracy, indicating its potential value for clinical application.
药物洗脱支架（DES）植入后发生的严重支架内再狭窄（ISR）可导致复发性心绞痛甚至急性心肌梗死，因此需要进行靶病变血运重建（TLR）。既往研究已证实单核细胞与高密度脂蛋白胆固醇比值（MHR）与DES植入后ISR之间的相关性。MHR预测DES植入后TLR的潜力仍是一个正在研究的领域，可能具有重要的临床意义。
对2014年12月1日至2022年12月1日期间连续474例行DES植入及后续冠状动脉造影的患者进行回顾性分析。根据患者是否接受TLR将其分为两个不同的组。为评估MHR对TLR的预测性能，我们采用多因素逻辑回归分析和受试者工作特征（ROC）曲线分析。
研究显示，与非TLR组相比，TLR组的MHR值显著升高（12.34对8.97；P<0.001）。MHR被确定为TLR的独立预测因子（比值比[OR]=1.162；95%置信区间[CI]：1.102-1.225）。曲线下面积（AUC）为0.712（95%CI：0.664-0.759）。当MHR超过10.98时，预测TLR的特异性为75.8%，敏感性为58.0%。当将MHR纳入包含既定危险因素的预测模型时，AUC有显著改善，从0.689提高到0.749（P<0.001）。此外，分类净重新分类改善（NRI）显著为0.183（P<0.001），综合判别改善（IDI）为0.074（P<0.001）。
MHR可作为DES植入后TLR的预测因子。将MHR纳入预测模型可提高模型的准确性，表明其在临床应用中的潜在价值。
