The Combined Effect of Platelet-to-HDL-Cholesterol Ratio and Glycemic Metabolism Status on the Prognosis of Patients Undergoing Percutaneous Coronary Intervention: A Large-Scale Retrospective Cohort Study.
The Platelet-to-HDL-cholesterol ratio (PHR), an emerging inflammatory biomarker, shows promise as a predictor in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). However, the association between PHR and glycemic metabolism status and their combined effects on the prognosis of CAD patients undergoing percutaneous coronary intervention (PCI) remains unclear.
A total of 31,761 CAD patients hospitalized for PCI were included. The primary endpoint was defined as major adverse cardiovascular events (MACEs). According to the median PHR levels, patients were grouped into higher levels of PHR (PHR-H) and lower levels of PHR (PHR-L) and further divided by glycemic status into four groups: PHR-H/T2DM, PHR-H/Non-T2DM, PHR-L/T2DM, PHR-L/Non-T2DM.
During the 1-year follow-up, 2258 (7.1%) MACEs occurred. Elevated PHR conferred 17% excess risk for MACEs. A 1-unit increase in LnPHR was associated with a 26% increased risk of MACEs in the T2DM cohort, and a 27% increase of MACEs risks in the non-T2DM cohort. Compared to those in PHR-H/T2DM group, patients in PHR-L/T2DM, PHR-H/Non-T2DM, PHR-L/Non-T2DM had significantly decreased risk of MACEs [adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.73-0.96, P =0.009; aHR: 0.81, 95% CI: 0.69-0.95, P =0.009; aHR: 0.70, 95% CI: 0.60-0.83, P <0.001; respectively]. Cox regression analysis also indicated the highest risk of MACEs among patients in PHR-H/T2DM group than in other groups (P for trend <0.001). Restricted cubic spline analyses revealed positive linear associations of PHR with MACEs, all-cause death, and unplanned target vessel revascularization, while a significant non-linear relationship between PHR and myocardial infarction. Additionally, subgroup analysis indicated consistent effects on MACEs within diverse subsets.
Elevated PHR levels combined with T2DM were associated with worse clinical outcomes after PCI at 1-year follow-up. The PHR may serve as a valuable predictor for identifying high-risk patients post-PCI, particularly in diabetic cohorts.
A total of 31,761 CAD patients hospitalized for PCI were included. The primary endpoint was defined as major adverse cardiovascular events (MACEs). According to the median PHR levels, patients were grouped into higher levels of PHR (PHR-H) and lower levels of PHR (PHR-L) and further divided by glycemic status into four groups: PHR-H/T2DM, PHR-H/Non-T2DM, PHR-L/T2DM, PHR-L/Non-T2DM.
During the 1-year follow-up, 2258 (7.1%) MACEs occurred. Elevated PHR conferred 17% excess risk for MACEs. A 1-unit increase in LnPHR was associated with a 26% increased risk of MACEs in the T2DM cohort, and a 27% increase of MACEs risks in the non-T2DM cohort. Compared to those in PHR-H/T2DM group, patients in PHR-L/T2DM, PHR-H/Non-T2DM, PHR-L/Non-T2DM had significantly decreased risk of MACEs [adjusted hazard ratio (aHR): 0.83, 95% confidence interval (CI): 0.73-0.96, P =0.009; aHR: 0.81, 95% CI: 0.69-0.95, P =0.009; aHR: 0.70, 95% CI: 0.60-0.83, P <0.001; respectively]. Cox regression analysis also indicated the highest risk of MACEs among patients in PHR-H/T2DM group than in other groups (P for trend <0.001). Restricted cubic spline analyses revealed positive linear associations of PHR with MACEs, all-cause death, and unplanned target vessel revascularization, while a significant non-linear relationship between PHR and myocardial infarction. Additionally, subgroup analysis indicated consistent effects on MACEs within diverse subsets.
Elevated PHR levels combined with T2DM were associated with worse clinical outcomes after PCI at 1-year follow-up. The PHR may serve as a valuable predictor for identifying high-risk patients post-PCI, particularly in diabetic cohorts.
Authors
Yang Yang, Li Li, Gao Gao, Gao Gao, Li Li, Wang Wang, Dou Dou, Wang Wang, Guo Guo, Qiu Qiu
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