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April 23, 2026BMC Cardiovascular Disorders0 citationsOpen Access

The predictive value of TC/HDL ratio in patients with acute myocardial infarction undergoing PCI

XZX D ZhangWWWei WangLXLi Xu

Key Result

A higher preprocedural TC/HDL ratio independently predicted a significantly increased risk of major adverse cardiovascular events (HR 2.521) at 6 months in patients with acute myocardial infarction undergoing PCI.

Key Points

  • The study aims to evaluate how effectively the TC/HDL ratio predicts major adverse cardiovascular events in patients post-myocardial infarction undergoing PCI.
  • Included 398 patients with acute myocardial infarction undergoing PCI.
  • Analyzed blood samples for TC/HDL ratio before PCI and followed patients for 6 months.
  • Utilized multivariate Cox regression and Kaplan-Meier survival analysis.
  • 25.4% of patients experienced major adverse cardiovascular events (MACEs).
  • Higher TC/HDL ratio significantly correlated with increased MACE risk (HR: 2.521; p < 0.001).
  • Patients with low TC/HDL ratio had better event-free survival compared to those with high levels (p < 0.001).

Study Design

Type

Cohort (n=398)

Multicenter

No

Structured PICO

Does a high TC/HDL ratio predict major adverse cardiovascular events in patients with acute myocardial infarction undergoing PCI?

P
Population
398 consecutive patients diagnosed with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI), median age 63, 74.1% male, based in China (Liaocheng People's Hospital). Key exclusions: malignant tumors, liver and kidney failure, immune diseases, mental diseases.
I
Intervention
High TC/HDL ratio (≥4.13) measured prior to PCI
C
Comparator
Low TC/HDL ratio (<4.13) measured prior to PCI
O
Outcome
Major adverse cardiovascular events (MACEs), a composite of malignant arrhythmia, all-cause death, new-onset HF, angina, and re-infarction at 6 months follow-upcomposite

An elevated TC/HDL ratio (≥4.13) is a strong, independent predictor of major adverse cardiovascular events at 6 months in patients with acute myocardial infarction undergoing PCI.

Main Result

Effect estimate: HR 2.521 (95% CI 1.902-3.343)

Absolute Event Rate: 42.7% vs 8%

p-value: p=<0.001

Limitations

  • relatively limited sample size
  • short follow-up period
  • retrospective design lacking detailed procedural and lesion-related information
  • relatively lower-risk AMI population

Abstract

Total cholesterol to high-density lipoprotein (TC/HDL) ratio has not been fully established following acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) in clinical practice. Therefore, we sought to evaluate the relationship between TC/HDL ratio and major adverse cardiovascular events (MACEs) in AMI undergoing PCI patients. 398 patients who subjected to AMI undergoing PCI were included in this study. Blood samples were obtained and analyzed before patients underwent PCI. Patients were followed up until 6 months after discharge, and MACEs were recorded. The incidence of MACEs was 25.4% (101 out of 398 patients). The TC/HDL ratio was significantly higher in the MACEs group compared to the non-MACEs group. In multivariate cox regression analysis, TC/HDL ratio level adjusted hazard ratio (HR): 2.521, 95% confidence interval (CI): 1.902–3.343; p < 0.001 was identified as a significant independent positive predictor of MACEs. In receiver operating characteristic curve, the area under the curve value for TC/HDL ratio in predicting MACEs was 0.748. Kaplan-Meier survival analysis revealed that patients in the low TC/HDL group had significantly higher event-free survival (EFS) rate compared to those in the high TC/HDL group (p < 0.001). TC/HDL ratio levels demonstrate moderate predictive value for MACEs in patients with AMI undergoing PCI, which providing additional information to the commonly used clinical markers.

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Cite This Study

Zhang et al. (2026) conducted a cohort in Acute myocardial infarction (AMI) (n=398). High TC/HDL ratio (≥4.13) vs. Low TC/HDL ratio (<4.13) was evaluated on Major adverse cardiovascular events (MACEs) (HR 2.521, 95% CI 1.902-3.343, p=<0.001). A higher preprocedural TC/HDL ratio independently predicted a significantly increased risk of major adverse cardiovascular events (HR 2.521) at 6 months in patients with acute myocardial infarction undergoing PCI.

synapsesocial.com/papers/69e9b91385696592c86ebff7https://doi.org/10.1186/s12872-026-05862-1
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