Abstract
BACKGROUND: Although percutaneous coronary intervention (PCI) is an effective treatment for coronary artery disease (CAD). However, the occurrence of in-stent restenosis (ISR) remains a critical issue in clinical practice. The non-high-density lipoprotein cholesterol (non-HDL) to high-density lipoprotein cholesterol (HDL) ratio (NHHR) is a novel lipid parameter that has been linked to various cardiovascular disorders. Nevertheless, its relationship with ISR after drug-eluting stent implantation remains to be elucidated. This study aims to explore the association between NHHR and ISR, evaluate its predictive value for ISR, and compare it with other lipid parameters. METHODS: This retrospective study included 594 CAD patients who underwent coronary angiography follow-up after surgery. Patients were divided into the ISR group (182 cases, 30.64%) and the non-ISR group (412 cases, 69.36%). Laboratory parameters of patients were measured and collected. Subsequently, both univariate and multivariate logistic regression models were used to identify the relevant influencing factors of ISR. The association between the NHHR and ISR was analyzed by restricted cubic splines regression, and the potential risk threshold preliminarily estimated. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value of NHHR for ISR. RESULTS: In the multivariate logistic regression models, the NHHR was significantly associated with the risk of ISR (max odds ratio = 1.806, P < 0.05 in all models). ROC curve analysis showed that the area under the curve for NHHR predicting ISR was 0.692 (95% Confidence Interval: 0.646-0.737), which was superior to those observed for low-density lipoprotein cholesterol (0.592, 95% Confidence Interval: 0.542-0.642), high-density lipoprotein cholesterol (0.407, 95% Confidence Interval: 0.358-0.456), triglyceride (0.58, 95% Confidence Interval: 0.531-0.629), total cholesterol (0.625, 95% Confidence Interval: 0.575-0.675), non-HDL (0.659, 95% Confidence Interval: 0.612-0.707), and LDL/HDL (0.634, 95% Confidence Interval: 0.585-0.682) (P < 0.001), indicating that NHHR has a relatively good predictive effect on ISR. The non-linear regression analysis results indicate that there is a nonlinear relationship and the risk of ISR occurrence increases with the increase of NHHR. CONCLUSION: The NHHR is independently associated with the risk of ISR after drug-eluting stent implantation in patients with CAD and exhibits a superior predictive capacity for ISR compared to other lipid parameters.