Wang Youpeng, Duan Juncang, Nagraj Sanjana, Kim Yong Hoon, Pan Yibin
Department of Cardiovascular Medicine, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China.
Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY, USA.
J Thorac Dis. 2025 May 30;17(5):3370-3379. doi: 10.21037/jtd-2025-517. Epub 2025 May 20.
Percutaneous coronary intervention has an irreplaceable role in the treatment of patients with acute myocardial infarction (AMI), but it may exacerbate distal microthrombosis, lead to the further impairment of myocardial perfusion and microcirculation, and ultimately lead to a poor prognosis. Therefore, it is important to evaluate biomarkers that help estimate the thrombosis burden and long-term prognosis of AMI patients. Recent studies have found that the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) is closely related to the development of cardiovascular disease. The present study aimed to investigate the value of the MHR in predicting the thrombosis burden and long-term prognosis of AMI patients.
From January 2018 to December 2019, the data of 324 AMI patients who underwent percutaneous coronary intervention at Affiliated Jinhua Hospital, Zhejiang University School of Medicine were retrospectively collected. All the patients underwent percutaneous coronary intervention. The thrombosis burden of the patients was assessed by thrombolysis in myocardial infarction (TIMI) grading. The MHR of the patients on admission was detected by automatic blood routine analyzer and automatic biochemical analyzer, and the MHR was calculated. According to the median of MHR, the patients were assigned to the high MHR group (n=162), and low MHR group (n=162). The patients were followed for 5 years. The incidences of recurrent major adverse cardiovascular events (MACEs) and mortality were observed, and the relationships between the MHR, and the thrombosis burden, MACE, and mortality were analyzed.
Significant differences were found in the left ventricular ejection fraction (LVEF), TIMI grade, the rate of 5-year MACE, and 5-year mortality between the high and low MHR groups (P<0.05). The MHR was valuable in predicting grade 4-5 TIMI, 5-year MACE, and 5-year mortality in the AMI patients, which had areas under the curve of the receiver operating characteristic (ROC) curves of 0.776 [95% confidence interval (CI): 0.712-0.840, P<0.001], 0.743 (95% CI: 0.681-0.805, P<0.001), and 0.790 (95% CI: 0.726-0.854, P<0.001), respectively. A high MHR was an independent risk factor for grade 4-5 TIMI, the 5-year MACE rate, and 5-year mortality in AMI patients, which had relative risks of 2.367 (95% CI: 1.165-4.807), 2.259 (95% CI: 1.088-4.690), and 2.524 (95% CI: 1.214-5.245).
The MHR can be used to predict the thrombosis burden and long-term prognosis of AMI patients.
经皮冠状动脉介入治疗在急性心肌梗死（AMI）患者的治疗中具有不可替代的作用，但它可能会加重远端微血栓形成，导致心肌灌注和微循环进一步受损，最终导致预后不良。因此，评估有助于估计AMI患者血栓负荷和长期预后的生物标志物具有重要意义。最近的研究发现，单核细胞与高密度脂蛋白胆固醇比值（MHR）与心血管疾病的发生密切相关。本研究旨在探讨MHR在预测AMI患者血栓负荷和长期预后中的价值。
回顾性收集2018年1月至2019年12月在浙江大学医学院附属金华医院接受经皮冠状动脉介入治疗的324例AMI患者的数据。所有患者均接受了经皮冠状动脉介入治疗。采用心肌梗死溶栓（TIMI）分级评估患者的血栓负荷。入院时通过自动血常规分析仪和自动生化分析仪检测患者的MHR，并计算MHR。根据MHR的中位数，将患者分为高MHR组（n = 162）和低MHR组（n = 162）。对患者进行5年随访。观察复发性主要不良心血管事件（MACE）的发生率和死亡率，并分析MHR与血栓负荷、MACE和死亡率之间的关系。
高、低MHR组之间在左心室射血分数（LVEF）、TIMI分级、5年MACE发生率和5年死亡率方面存在显著差异（P<0.05）。MHR在预测AMI患者的4-5级TIMI、5年MACE和5年死亡率方面具有价值，其受试者操作特征（ROC）曲线下面积分别为0.776 [95%置信区间（CI）：0.712-0.840，P<0.001]、0.743（95%CI：0.681-0.805，P<0.001）和0.790（95%CI：0.726-0.854，P<0.001）。高MHR是AMI患者4-5级TIMI、5年MACE发生率和5年死亡率的独立危险因素，其相对危险度分别为2.367（95%CI：1.165-4.807）、2.259（95%CI：1.088-4.690）和2.524（95%CI：1.214-5.245）。
MHR可用于预测AMI患者的血栓负荷和长期预后。
