Kocaeli Med J. 2025; 14(2): 128-134 | DOI: 10.5505/ktd.2025.89656

Prognostic and Predictive Value of the Non-HDL Cholesterol/HDL Cholesterol Ratio in Patients with Stent Thrombosis Presenting with ST-Segment Elevation Myocardial Infarction

Özgür Selim Ser¹, Gökhan Çetinkal¹, Yalçýn Dalgýç², Betül Balaban Koçaþ¹, Emre Daðlýoðlu¹, Erkan Kalendar¹, Metin Çaðdaþ², Süleyman Sezai Yýldýz¹, Kadriye Kýlýçkesmez^1
1Cemil Taþçýoðlu City Hospital, Department Of Cardiology, Istanbul, Turkey.
²Kocaeli City Hospital, Department Of Cardiology, Kocaeli, Turkey.

INTRODUCTION: The relationship between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (non-HDL-C/HDL-C ratio, NHHR) and stent thrombosis (ST) in the setting of ST-elevation myocardial infarction (STEMI) has been understudied. We aimed to evaluate the prognostic value of NHHR in patients presenting with STEMI due to ST.
METHODS: This retrospective study included 168 patients who underwent primary PCI for ST-related STEMI between January 2020 and April 2024. The primary outcome was 1-year all-cause mortality. Patients were stratified according to NHHR: <3 or ≥3.
RESULTS: During 1-year follow-up, 35 patients (20.8%) died. Compared with survivors, non-survivors were older (64 vs. 58 years, p = 0.049), more often female (48.6% vs. 30.1%, p = 0.040), and had higher rates of hypercholesterolemia, heart failure, and Killip class ≥2 (all p < 0.05). They also had lower LVEF (41% vs. 45%, p = 0.009), and higher admission levels of creatinine, CRP, and glucose. HDL-C and hemoglobin were significantly lower in non-survivors. An NHHR ≥3 was more frequent in the mortality group (71.4% vs. 51.1%, p = 0.032), and associated with higher 1-year mortality (26.8% vs. 13.3%, p = 0.032). In multivariate Cox regression, NHHR ≥3 remained an independent predictor of 1-year mortality (HR = 2.751; 95% CI, 1.048–7.221; p = 0.040).
DISCUSSION AND CONCLUSION: Among patients presenting with STEMI due to ST, an elevated non-HDL-C/HDL-C ratio was independently associated with increased 1-year all-cause mortality. NHHR may serve as a simple, accessible biomarker for risk stratification in this high-risk population.

Keywords: stent thrombosis, ST-elevation myocardial infarction, non-HDL/HDL cholesterol ratio, mortality

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Segment Yükselmeli Miyokart Enfarktüsü ile Baþvuran Stent Trombozlu Hastalarda Non-HDL Kolesterol/HDL Kolesterol Oranýnýn Prognostik ve Prediktif Deðeri

Özgür Selim Ser¹, Gökhan Çetinkal¹, Yalçýn Dalgýç², Betül Balaban Koçaþ¹, Emre Daðlýoðlu¹, Erkan Kalendar¹, Metin Çaðdaþ², Süleyman Sezai Yýldýz¹, Kadriye Kýlýçkesmez^1
1Cemil Taþçýoðlu Þehir Hastanesi, Kardiyoloji Kliniði, Ýstanbul, Türkiye.
²Kocaeli Þehir Hastanesi, Kardiyoloji Bölümü, Kocaeli, Türkiye.

GÝRÝÞ ve AMAÇ: Non-HDL kolesterol ile HDL kolesterol oraný (non-HDL-C/HDL-C oraný; NHHR) ile stent trombozu (ST) zemininde geliþen ST-segment elevasyonlu miyokart enfarktüsü (STEMI) arasýndaki iliþki yeterince araþtýrýlmamýþtýr. Bu çalýþmada, NHHR’nin bu hasta grubundaki prognostik deðerini deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Ocak 2020 ile Nisan 2024 tarihleri arasýnda ST’ye baðlý STEMI nedeniyle primer PTCA uygulanan toplam 168 hasta retrospektif olarak incelendi. Birincil sonlaným noktasý, 1 yýllýk tüm nedenlere baðlý mortaliteydi. Hastalar NHHR deðerlerine göre <3 ve ≥3 olmak üzere iki gruba ayrýldý
BULGULAR: Bir yýllýk takip süresince 35 hasta (%20,8) hayatýný kaybetti. Mortalite grubundaki hastalar, sað kalanlara kýyasla daha yaþlýydý (64 vs. 58 yaþ, p = 0,049), daha sýk kadýn cinsiyetteydi (%48,6 vs. %30,1, p = 0,040) ve hiperkolesterolemi, kalp yetersizliði ve baþvuru Killip ≥2 oranlarý daha yüksekti (tüm p < 0,05). Bu hastalarda LVEF daha düþüktü (yüzde 41 vs. 45, p = 0,009) ve baþvuru glukoz, kreatinin, CRP deðerleri anlamlý olarak yüksekti. Ayrýca, HDL kolesterol ve hemoglobin düzeyleri mortalite grubunda daha düþüktü. NHHR ≥3 olan hastalarýn oraný mortalite grubunda anlamlý olarak daha fazlaydý (%71,4 vs. %51,1, p = 0,032) ve bu hastalarda 1 yýllýk mortalite oraný daha yüksekti (%26,8 vs. %13,3, p = 0,032). Çok deðiþkenli Cox regresyon analizinde, NHHR ≥3 deðeri 1 yýllýk mortalite için baðýmsýz bir öngördürücü olarak saptandý (HR = 2,751; %95 GA: 1,048–7,221; p = 0,040).
TARTIÞMA ve SONUÇ: ST’ye baðlý STEMI ile baþvuran hastalarda 1 yýllýk mortalite halen yüksektir. Non-HDL-C/HDL-C oranýnýn yüksek oluþu, bu hasta grubunda artmýþ mortalite ile baðýmsýz olarak iliþkili bulunmuþtur. NHHR, bu yüksek riskli hasta grubunda kolay eriþilebilir, basit ve deðerli bir risk belirteci olabilir.

Anahtar Kelimeler: stent trombozu, ST elevasyonlu miyokart enfarktüsü, non-HDL/HDL kolesterol oraný, mortalite

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