Aydin Fatih, Murat Bektaş, Murat Selda, Dağhan Hazal
Department of Cardiology, Eskisehir City Hospital, 26080 Eskisehir, Türkiye.
Department of Cardiology, Eskisehir Osmangazi University, 26040 Eskisehir, Türkiye.
Diagnostics (Basel). 2025 Sep 2;15(17):2222. doi: 10.3390/diagnostics15172222.
: Present ACS risk stratification predominantly depends on LDL-C, yet its diagnostic accuracy for coronary plaque burden remains limited. We examined whether extensive lipid profiling, specifically the TG/HDL-C ratio, could function as a more effective diagnostic instrument for forecasting significant plaque burden in treatment-naïve first-time ACS patients. : Among 722 ACS patients screened, 376 treatment-naïve patients undergoing PCI with complete lipid data were included. Exclusions ( = 346) were due to prior CAD, lipid-lowering therapy, renal/hepatic dysfunction, malignancy, pregnancy, or incomplete data. Coronary plaque burden was quantified by QCA, and patients were stratified by lesion count (0, 1, 2, 3, ≥4). The levels of lipids (LDL-C, HDL-C, TC, TG) and their ratios (LDL/HDL-C, TC/HDL-C, TG/HDL-C) were measured. Analyses included ANOVA (with Bonferroni correction), correlation, ordinal regression, and logistic regression (≥3 vs. <3 lesions). ROC analysis determined thresholds. : TG/HDL-C ratio increased progressively from 3.3 (0 lesions) to 5.3 (≥4 lesions). After Bonferroni correction, only TG/HDL-C retained significance ( = 0.009). Logistic regression confirmed TG/HDL-C as an independent predictor of high plaque burden (OR 1.25, 95% CI 1.09-1.42, = 0.004), outperforming LDL-C. : TG/HDL-C ratio is a superior diagnostic biomarker compared to LDL-C for identifying extensive coronary plaque burden. Integration into admission lipid profiling offers a cost-effective, actionable tool.
目前急性冠状动脉综合征（ACS）的风险分层主要依赖于低密度脂蛋白胆固醇（LDL-C），但其对冠状动脉斑块负荷的诊断准确性仍然有限。我们研究了全面的血脂分析，特别是甘油三酯/高密度脂蛋白胆固醇（TG/HDL-C）比值，是否能作为一种更有效的诊断工具，用于预测初治首次发生ACS患者的显著斑块负荷。
在722例接受筛查的ACS患者中，纳入了376例接受经皮冠状动脉介入治疗（PCI）且有完整血脂数据的初治患者。排除的346例患者是由于既往有冠心病（CAD）、降脂治疗、肾/肝功能不全、恶性肿瘤、妊娠或数据不完整。通过定量冠状动脉造影（QCA）对冠状动脉斑块负荷进行量化，并根据病变数量（0、1、2、3、≥4）对患者进行分层。测量血脂水平（LDL-C、HDL-C、总胆固醇（TC）、甘油三酯（TG））及其比值（LDL/HDL-C、TC/HDL-C、TG/HDL-C）。分析包括方差分析（采用Bonferroni校正）、相关性分析、有序回归分析和逻辑回归分析（≥3个病变与<3个病变）。通过ROC分析确定阈值。
TG/HDL-C比值从3.3（0个病变）逐渐增加到5.3（≥4个病变）。经过Bonferroni校正后，只有TG/HDL-C具有显著性（P = 0.009）。逻辑回归分析证实TG/HDL-C是高斑块负荷的独立预测因子（比值比[OR]为1.25，95%置信区间[CI]为1.09 - 1.42，P = 0.004），优于LDL-C。
与LDL-C相比，TG/HDL-C比值是识别广泛冠状动脉斑块负荷的更优诊断生物标志物。将其纳入入院时的血脂分析可提供一种具有成本效益且可操作的工具。
