Huang Jinyong, Zhang Junyi, Xie Zhonghui, Li Linjie, Chen Meiyan, Li Yongle, Yu Xiangdong, Dong Shaozhuang, Wang Qing, Chen Jun, Yang Qing, Xu Shaopeng
Department of Cardiology, Tianjin Medical University General Hospital, No. 154, Anshan Road, Heping District, Tianjin, 300052, China.
Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
Lipids Health Dis. 2025 Sep 13;24(1):280. doi: 10.1186/s12944-025-02707-2.
This study looked into how predictive in ST-segment elevation myocardial infarction (STEMI) is the high-sensitivity C-reactive protein-to-albumin ratio (hsCAR) as well as glycated hemoglobin to high-density lipoprotein cholesterol (HbA1c/HDL-c) ratio.
This retrospective cohort research was carried out on 1,177 patients having STEMI who were given percutaneous coronary intervention (PCI). For major adverse cardiovascular events (MACE), the independent and combined predictive values of the HbA1c/HDL-c ratio (threshold ≥ 6.61) and hsCAR (threshold ≥ 0.18) were assessed. MACE was an amalgamation of death from all causes, ischemia-induced revascularization, myocardial infarction not leading to death, heart failure hospitalization, and cerebrovascular events. The team used Cox regression models, causal mediation examination, and receiver operating characteristic curves to assess prognostic performance and mechanistic pathways, and compared them with the Global Registry of Acute Coronary Events (GRACE) risk score.
The interquartile range for follow-up was 79 to 672 days, with 461 median days. A raised HbA1c/HDL-c ratio (≥ 6.61) and hsCAR (≥ 0.18) independently predicted MACE, with 1.51 (95% confidence interval [CI]: 1.26-1.81; P < 0.001) as well as 1.84 (95% CI: 1.53-2.21; P = 0.005) hazard ratios (HRs), respectively. Combined use enhanced risk stratification, with the high HbA1c/HDL-c-high hsCAR group showing the highest risk (adjusted HR 2.19, 95% CI: 1.67-2.87; P < 0.001). Causal mediation examination revealed that coronary lesion complexity partially mediated these associations; the SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) and the residual SYNTAX scores were responsible for accounting for 24.2%/17.7% of the hsCAR effect and 16.8%/25.2% of the HbA1c/HDL-c ratio effect, respectively. Compared with the individual markers or the GRACE risk score, the combined biomarker model demonstrated superior discriminatory capacity (area under the curve = 0.63, 95% CI = 0.60-0.66; P < 0.001), with significant improvement in integrated discrimination.
The integration of HbA1c/HDL-c and hsCAR can significantly improve risk stratification in patients with STEMI, outperforming traditional scoring systems and assisting in the precise management of individuals at risk.
本研究探讨了高敏C反应蛋白与白蛋白比值（hsCAR）以及糖化血红蛋白与高密度脂蛋白胆固醇比值（HbA1c/HDL-c）对ST段抬高型心肌梗死（STEMI）的预测价值。
本回顾性队列研究对1177例行经皮冠状动脉介入治疗（PCI）的STEMI患者进行。评估了HbA1c/HDL-c比值（阈值≥6.61）和hsCAR（阈值≥0.18）对主要不良心血管事件（MACE）的独立及联合预测价值。MACE包括各种原因导致的死亡、缺血性血管重建、非致死性心肌梗死、心力衰竭住院及脑血管事件。研究团队使用Cox回归模型、因果中介分析及受试者工作特征曲线评估预后性能和作用机制途径，并与急性冠状动脉事件全球注册研究（GRACE）风险评分进行比较。
随访的四分位数间距为79至672天，中位数为461天。升高的HbA1c/HDL-c比值（≥6.61）和hsCAR（≥0.18）独立预测MACE，风险比（HR）分别为1.51（95%置信区间[CI]：1.26 - 1.81；P < 0.001）和1.84（95% CI：1.53 - 2.21；P = 0.005）。联合使用可增强风险分层，HbA1c/HDL-c高 - hsCAR高组风险最高（调整后HR 2.19，95% CI：1.67 - 2.87；P < 0.001）。因果中介分析显示冠状动脉病变复杂性部分介导了这些关联；PCI与TAXUS和心脏手术的协同作用（SYNTAX）及残余SYNTAX评分分别占hsCAR效应的24.2%/17.7%和HbA1c/HDL-c比值效应的16.8%/25.2%。与单个标志物或GRACE风险评分相比，联合生物标志物模型具有更好的鉴别能力（曲线下面积 = 0.63，95% CI = 0.60 - 0.66；P < 0.001），综合鉴别能力有显著提高。
HbA1c/HDL-c与hsCAR联合可显著改善STEMI患者的风险分层，优于传统评分系统，有助于对高危个体进行精准管理。
