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

The predictive value of TC/HDL ratio in patients with acute myocardial infarction undergoing PCI | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The predictive value of TC/HDL ratio in patients with acute myocardial infarction undergoing PCI Xin Zhang, Wei Wang, Li Xu, Na Song, Tao Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8417160/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 11 You are reading this latest preprint version Abstract Background Total cholesterol to high-density lipoprotein (TC/HDL) ratio was yet to be discovered 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. Methods 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. Results 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): 2.529, 95% confidence interval (CI): 1.909–3.352; 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). Conclusions TC/HDL ratio levels have strong ability for MACEs in patients with AMI undergoing PCI, which providing additional information to the commonly used clinical markers. TC/HDL AMI PCI MACEs Predictive Value Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. As a life-threatening coronary event, AMI can lead to sudden cardiac death (SCD) and represents the most severe clinical manifestation of coronary artery disease (CAD). AMI is classified into two main types: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) [ 1 ]. Complications following infarction include heart failure (HF), cardiac rupture, arrhythmias, ventricular septal rupture, and cardiogenic shock [ 2 – 4 ]. Although the incidence of post-AMI complications has declined with the use of reperfusion techniques, this disease continues to impose a substantial burden on human health. Therefore, early identification of predictors for these complications in AMI is urgently needed to reduce mortality. High-density lipoprotein (HDL) is known for its anti-inflammatory and antioxidant properties, which help protect cardiomyocytes from oxidative stress and may slow the progression of coronary artery stenosis. Conversely, elevated total cholesterol (TC) levels are implicated in promoting inflammation and oxidative stress, thereby increasing the risk of cardiovascular diseases (CVD). The TC/HDL ratio, a widely used marker of lipid metabolism, reflects the overall balance of cholesterol. By integrating the protective effects of HDL with the atherogenic potential of TC, it provides a more comprehensive cardiovascular risk profile than individual lipid parameters, establishing its value as an indicator in cardiovascular and metabolic research [ 5 ]. Many studies have investigated the relationship between serum TC/HDL ratio and metabolic diseases such as ischemic heart disease (IHD), micronutrients intakes, osteoporosis and premature myocardial infarction [ 6 – 8 ], but the relationship between the TC/HDL ratio and the prognosis of AMI patients is unclear. Therefore, the present study aimed to investigate the predictive value of preprocedural TC/HDL ratio for major adverse cardiovascular events (MACEs) in AMI patients undergoing percutaneous coronary intervention (PCI). These findings could inform more effective risk assessment and management strategies, thereby helping to reduce the global burden of cardiovascular disease. Methods Study design and participants In this retrospective study, the study population comprised 398 patients admitted to the Department of Cardiology of Liaocheng People's Hospital from October 2023 to July 2024, all of whom were diagnosed with AMI and subsequently underwent PCI. The diagnosis of AMI was based on the Fourth Universal Definition of Myocardial Infarction (2018) [9]. Patients with malignant tumors, liver and kidney failure, immune diseases, mental diseases and other diseases affecting their lives were excluded from our study. This study was conducted in accordance with the Declaration of Helsinki (1989) and was approved by the Ethics Committee of Liaocheng People's Hospital. The requirement for written informed consent was waived, due to the analysis used anonymized retrospective data. Clinical data collection and follow-up of patients Data on baseline characteristics and past medical history, such as sex, age, smoking status, family history of CAD, hypertension, and diabetes mellitus (DM), were collected from the hospital medical record system and follow-up records. Venous blood samples were collected from all patients prior to PCI and sent to the hospital's central laboratory for analysis. Measurements included total cholesterol (TC), high-density lipoprotein (HDL), transaminase, creatinine, and other relevant parameters, following standard laboratory procedures. Following the procedure, all patients received conventional evidence-based medical therapy for CAD. This included dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, lipid-lowering agents such as statins, and other indicated treatments. Patients were followed up for 6 months after discharge via telephone interviews or medical record reviews. The occurrences of MACEs were recorded. A total of 28 patients were lost to follow-up and excluded, resulting in a final cohort of 398 AMI patients who completed the study for evaluation. Definitions The endpoint of this study was the occurrence of MACEs, including malignant arrhythmia, all-cause death, new-onset HF, angina, and re-infarction. Malignant arrhythmia was identified by electrocardiogram or Holter monitoring. Death was defined as all-cause mortality. The diagnosis of new-onset HF was based on clinical signs and symptoms, supported by findings from physical examination, echocardiography, or chest X-ray. Angina or re-infarction was diagnosed according to ischemic symptoms accompanied by electrocardiographic changes, with or without elevated serum cardiac enzyme levels. Statistical analysis All statistical analyses were performed using SPSS software (version 29.0; IBM Corp.). Continuous variables were assessed for normality with the Shapiro-Wilk test. Normally distributed data are presented as mean ± standard deviation and compared using the independent samples t -test. Non-normally distributed data are expressed as median (interquartile range, IQR) and compared with the Mann-Whitney U test. Categorical variables are summarized as frequency (percentage) and compared using the chi-square ( χ² ) test. Univariate logistic regression was performed to identify factors associated with MACEs, with variables yielding a p-value < 0.05 being included in the subsequent multivariate model. The predictive performance of the TC/HDL ratio was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal cutoff value was determined by maximizing Youden's index. Short-term event-free survival (EFS) was analyzed with the Kaplan-Meier method and compared using the log-rank test. A two-sided p-value < 0.05 was considered statistically significant for all analyses. Results Baseline characteristics of the patients A total of 398 AMI patients who underwent PCI were enrolled in this study, including 295 male patients and 103 female patients. Patients were divided into two groups based on median TC/HDL ratio levels: a high TC/HDL ratio group (TC/HDL≥4.13; n=199) and a low TC/HDL ratio group (TC/HDL<4.13; n=199). The high TC/HDL ratio group patients were younger, had higher levels of hemoglobin, white blood cell, platelet, albumin, TC, LDL, triglyceride (TG) and lower HDL levels. The difference between the two groups was detailed in Table 1. Patients were categorized into two groups based on the occurrence of MACEs: the MACEs group (n=101) and the non-MACEs group (n=297). As shown in Table 2, compared to the non-MACEs group, patients in the MACEs group were younger and had a higher prevalence of males, smoking, hypertension, DM, family history of CAD, and emergency PCI. They also exhibited significantly higher levels of hemoglobin, platelets, creatinine, albumin, TC, LDL, and TG, but lower levels of HDL. The levels of TC/HDL ratio in MACEs and non-MACEs groups As shown in Figure 1, the TC/HDL ratio was significantly higher in the MACEs group compared to the non-MACEs group (p<0.001). Correlation of TC/HDL ratio and clinical characteristics TC/HDL ratio levels were positively correlated with LDL levels (r=0.631, p<0.001; Figure 2a); platelet levels (r=0.175, p<0.001; Figure 2b); hemoglobin levels (r=0.203, p<0.001; Figure 2c); and TG levels (r=0.381, p<0.001; Figure 2d). While, TC/HDL ratio levels were negatively correlated with age (r=-0.196, p<0.001; Figure 2e). However, no significant correlation was found between the TC/HDL ratio and ejection fraction (r=0.023, p=0.642; Figure 2f). Similarly, the ratio was not correlated with fibrinogen (r=0.075, p=0.135; Figure 2g) or D-dimer levels (r=0.042, p=0.400; Figure 2h). Clinical outcomes of MACEs The incidence of MACEs was 25.4% (101 out of 398 patients), including death (n=1), angina or re-infarction (n=82), malignant arrhythmia (n=3), and new-onset HF (n=15). The total MACEs rate was significantly higher in the high TC/HDL ratio group compared to the low ratio group (42.7% vs. 8.0%, p<0.001). Furthermore, the incidence of angina or reinfarction and new-onset HF between the two groups was statistically significant (both p<0.001). However, there were no significant differences in the incidence of death or malignant arrhythmia between the two groups (as shown in Table 3). Independent predictors for MACEs in AMI patients As demonstrated in Table 4, potential confounders associated with MACEs were analyzed using univariate analysis. Variables with p-value <0.05 in univariate analysis were included in multivariate Cox regression analysis. After adjusting for gender, age, smoking, hypertension, DM, LDL levels, and TC/HDL ratio level [adjusted hazard ratio (HR): 2.529, 95% confidence interval (CI): 1.909-3.352; p<0.001] was identified as a significant positive independent predictor of MACEs. In addition, HDL level (adjusted HR: 0.044, 95% CI: 0.014-0.137; p<0.001) was also an independent predictor of MACEs. While, TC level (adjusted HR: 0.542, 95% CI: 0.286-1.029; p=0.061) was not. Kaplan-Meier survival curves of TC/HDL ratio in AMI patients during follow-up 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) (Figure 3). As a result, patients with lower TC/HDL levels have a better prognosis than those with high TC/HDL levels. ROC curve to evaluate the predictive value of TC/HDL ratio for MACEs To test the performance of TC/HDL ratio in predicting MACEs, ROC curve analysis was conducted. The AUC values for TC/HDL ratio were 0.748 (95% CI: 0.698-0.798; p<0.001) with 89.1% sensitivity and 58.9% specificity (Figure 4a). The AUC values for HDL were 0.618 (95% CI: 0.554-0.682; p<0.001) with 81.1% sensitivity and 37.6% specificity (Figure 4b). Discussion While advancements in PCI have improved outcomes for AMI patients, long-term prognosis and the risk of MACEs remain a critical concern. This study demonstrates that the TC/HDL ratio is a significant predictor of MACEs in AMI patients undergoing PCI. ROC curve analysis confirmed its robust predictive value, highlighting its potential utility in risk stratification. LDL is the principal atherogenic component of TC, which also includes HDL and VLDL. Elevated LDL levels are an established independent risk factor for CVD, as LDL promotes atherosclerosis and thrombosis through multiple mechanisms. Consequently, authoritative international guidelines, such as those from the ACC/AHA, unequivocally endorse LDL-lowering as a fundamental strategy in the management of atherosclerotic cardiovascular disease (ASCVD). HDL levels are well-established to correlate with a reduced risk of cardiovascular events [ 11 ]. The underlying mechanism centers on reverse cholesterol transport, a process whereby HDL mediates cholesterol removal from peripheral tissues. This mechanism not only reduces the accumulation of atherogenic apolipoprotein B in the arterial wall to facilitate cholesterol efflux from plaques but also triggers an influx of phagocytic cells that clear necrotic material, thereby promoting plaque stabilization [ 12 ]. Previous studies indicate that HDL promotes endothelial homeostasis by enhancing nitric oxide (NO) production and suppressing key pathways involved in vascular inflammation and apoptosis [ 13 , 14 ]. However, this protective function of HDL is compromised in patients with CAD, manifesting as an impaired ability to stimulate NO generation and support endothelial repair [ 15 , 16 ]. Venkat et al. [ 17 ] demonstrated that HDL levels are inversely correlated with fibrous, fibrous fatty, total non-calcified plaque, and total plaque volume. TC/HDL ratio has been reported as a risk indicator with greater predictive value than isolated parameters, particularly LDL [ 18 ]. Therefore, the TC/HDL ratio reflects the cholesterol balance between atherogenic and anti-atherogenic lipoprotein particles. Many previous studies have evaluated the association between cholesterol levels and CVD risk, both in elderly and younger populations [ 19 , 20 ]. In our study, multivariable Cox analysis showed that TC was not a meaningful predictor of MACEs after adjusting for confounding factors (p = 0.061). Future studies including larger sample sizes and extended follow-up may further clarify the significance of TC in MACEs. Low HDL levels are associated with an increased incidence of cardiovascular mortality and recurrent MI [ 21 ]. Conversely, high HDL levels may correlate with a reduced risk of cardiovascular events, particularly in STEMI patients, suggesting a potential protective effect [ 16 ]. In our study, the AUC values for HDL were 0.618, indicated that the HDL had a predictive value for MACEs in this population. However, some studies revealed that increasing HDL levels may not reduce future cardiovascular events or atherosclerotic burden [ 22 ]. It is increasingly appreciated that the metabolism and regulation of HDL are far more complex than once understood, being highly dynamic and subject to context-dependent modification, notably during the progression of various disease states [ 23 , 24 ]. The relationship between HDL and CVD risk and prognosis remains controversial, and further mechanism and clinical studies are needed. In a cohort study of middle-aged women with a mean follow-up of 17 years, researchers found a strong association with IHD for TC/HDL ratio, they found that TC/HDL had a slightly higher predictive ability for IHD than non-HDL [ 7 ]. In addition, the results of a prospective cohort study involving 34294 participants showed a significant positive correlation between TC/HDL ratio and stroke occurrence [ 25 ]. The results mentioned above align with our research outcomes. Another study by Zhou et al. [ 26 ] demonstrated that the TC/HDL ratio > 4.22 had higher cardiovascular mortality. Moreover, people with TC/HDL at 4.0, there was 55.2% and 24.0% increased risks of CVD hospitalization within 2 years and rehospitalization after 90 days of prior CVD hospitalization comparing patients with TC/HDL at 2.8, respectively [ 27 ]. In our study, an elevated TC/HDL ratio was associated with an increased incidence of MACEs. Our subgroup analysis confirmed that patients who experienced MACEs had a significantly higher TC/HDL ratio compared to those in the non-MACEs group. Furthermore, the incidences of angina, reinfarction, and new-onset HF were all significantly greater in the MACEs group, which is consistent with findings from previous studies. The incidence of death or malignant arrhythmia, however, was not significantly different between the groups. According to Kaplan-Meier survival analysis, a lower TC/HDL level was associated with a better prognosis, suggesting its prognostic utility. This was further supported by ROC curve analysis, which indicated that the TC/HDL ratio (AUC: 0.748) had a better predictive value for MACEs than HDL alone (AUC: 0.618). This study has several notable limitations. First, the findings are constrained by a relatively short follow-up duration and a limited sample size. Second, the male predominance in our cohort (2.9:1) may introduce gender bias and precludes the generalizability of the results to the female population. Finally, as this was a single-center study involving an AMI population from northern China, the findings may not be fully representative of other demographic or geographic groups within China. Future studies with longer follow-up, larger and more balanced cohorts, and multi-center designs are warranted to validate our conclusions. Conclusion High TC/HDL ratio levels are associated with the development of MACEs in patients with AMI undergoing PCI, which providing additional information to the commonly used clinical markers. Declarations Acknowledgements The authors thank the patients, nurses, study coordinators and all investigators involved in this study, without whom the study would not have been possible. Author contributions TL put forward conception and study design. WW, LX and NS researched data. XZ wrote the manuscript and contributed to statistical analysis. XZ and TL edited and contributed to the manuscript, data interpretation, and discussion. All authors have read and approved the final version of the manuscript. Funding This work was supported by the “Key R&D Program of Liaocheng City” (2024YD36). Data availability Some or all datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request. Ethical approval and informed consent The studies involving human participants were reviewed and approved by the Local Ethics Committee of the Liaocheng People's Hospital. The requirement for written informed consent was waived, due to the analysis used anonymized retrospective data. Competing interests The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported. Clinical trial number: not applicable. 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Tables Table 1. Basic characteristics of studied patients according to TC/HDL levels. Characteristics High TC/HDL Low TC/HDL p value n = 199 n = 199 Age (year) 61 (19) 63.7 ± 10.4 0.006 Male gender, n (%) 153 (76.9) 142 (71.4) 0.208 Smoking, n (%) 97 (48.7) 104 (52.7) 0.483 Hypertension, n (%) 110 (55.3) 119 (59.8) 0.361 DM, n (%) 65 (37.7) 48 (24.1) 0.059 Family history, n (%) 17 (8.5) 18 (9) 0.860 Neutrophil percentage (%) 70.2 (17.4) 69.81 ± 12.41 0.993 Hemoglobin (g/L) 139.15 ± 16.85 134.67 ± 16.40 0.008 WBC count (×10 9 /L) 8.43 (4.22) 8.01 (3.45) 0.043 Platelet (×10 9 /L) 244.1 ± 51.53 222 (69) 0.006 D-dimer (mg/L) 0.30 (0.36) 0.27 (0.33) 0.449 Fibrinogen (g/L) 3.13 (1.09) 3.08 (0.81) 0.302 Creatinine (umol/L) 63.0 ± 22.1 62.6 (23.5) 0.817 Albumin (g/L) 41 (7) 39 (6) < 0.001 TG (mmol/L) 1.53 (1.08) 1.04 (0.64) < 0.001 HDL (mmol/L) 1.09 ± 0.22 1.21 ± 0.27 < 0.001 LDL (mmol/L) 3.40 ± 0.73 2.59 ± 0.75 < 0.001 TC (mmol/L) 5.2 (1.27) 4.24 ± 1.10 < 0.001 ALT (U/L) 25 (17) 25 (16) 0.791 AST (U/L) 32 (37) 33 (41) 0.793 EF (%) 52 (13) 52 (13) 0.939 LVEDD (mm) 46 (5) 45 (5) 0.083 Emergency PCI, n (%) 69 (34.7) 57 (28.6) 0.196 Abbreviation: TC: Total cholesterol; HDL: High-density lipoprotein; DM: Diabetes mellitus; WBC: White blood cell; TG: Triglyceride; LDL: Low-density lipoprotein; ALT: Alanine aminotransferase; AST: Aspartate transaminase; EF: Ejection fraction; LVEDD: Left ventricular end-diastolic diameter; PCI: Percutaneous coronary Intervention. Table 2. Basic characteristics of studied patients according to MACEs or non-MACEs. Characteristics MACEs Non-MACEs p value n = 101 n = 297 Age (year) 61 (20) 63 (16) 0.023 Male gender, n (%) 85 (84.2) 210 (70.7) 0.008 Smoking, n (%) 66 (65.3) 135 (45.5) < 0.001 Hypertension, n (%) 71 (70.3) 158 (53.2) 0.002 DM, n (%) 41 (40.6) 72 (24.2) 0.002 Family history, n (%) 18 (17.8) 17 (5.7) < 0.001 Neutrophil percentage (%) 68.5 ± 11.8 71.2 (17.2) 0.135 Hemoglobin (g/L) 142 (24) 135.5 ±16.6 0.003 WBC count (×10 9 /L) 8.95 ± 2.83 8.06 (3.76) 0.185 Platelet (×10 9 /L) 245.6 ± 60.9 227 (74) 0.042 D-dimer (mg/L) 0.30 (0.36) 0.28 (0.33) 0.60 Fibrinogen (g/L) 3.19 (1.17) 3.08 (0.82) 0.362 Creatinine (umol/L) 67.4 (25.4) 61.9 (22.2) 0.046 Albumin (g/L) 41.55 ± 4.78 39 (6) 0.004 TG (mmol/L) 1.44 (1.24) 1.16 (0.79) 0.001 HDL (mmol/L) 1.08 ± 0.24 1.16 (0.3) < 0.001 LDL (mmol/L) 3.21 ± 0.71 2.92 ± 0.87 0.001 TC (mmol/L) 4.94 ± 1.05 4.65 ± 1.22 0.034 ALT (U/L) 28 (19) 24 (16) 0.034 AST (U/L) 32 (34) 32 (41) 0.708 EF (%) 52 (13) 52 (14) 0.589 LVEDD (mm) 46 (4) 46 (5) 0.150 Emergency PCI, n (%) 69 (34.7) 57 (28.6) < 0.001 Abbreviation: MACEs: Major adverse cardiovascular events; DM: Diabetes mellitus; WBC: White blood cell; TG: Triglyceride; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; TC: Total cholesterol; ALT: Alanine aminotransferase; AST: Aspartate transaminase; EF: Ejection fraction; LVEDD: Left ventricular end-diastolic diameter; PCI: Percutaneous coronary Intervention. Table 3. Major adverse cardiac events according to TC/HDL ratio Complications High TC/HDL ratio (n = 199) Low TC/HDL ratio (n = 199) p value Death, n (%) 0 (0) 1 (0.5) 1.0 Angina or MI, n (%) 68 (34.2) 14 (7) < 0.001 Heart failure, n (%) 15 (7.5) 0 (0) < 0.001 Malignant arrhythmia, n (%) 2 (1.0) 1 (0.5) 1.0 Total MACEs, n (%) 85 (42.7) 16 (8.0) < 0.001 Abbreviation: TC: Total cholesterol; HDL: High-density lipoprotein; MI: myocardial infarction; MACEs: Major adverse cardiac events. Table 4. Cox proportional hazard analysis for predictors of MACEs. Variables HR 95% CI p value Univariate analysis Male 1.989 1.166-3.392 0.012 Age 0.977 0.961-0.994 0.008 Smoking status 2.023 1.343-3.048 < 0.001 Hypertension 2.012 1.312-3.083 < 0.001 DM 2.085 1.401-3.104 < 0.001 Platelet 1.003 1.000-1.006 0.057 WBC count 0.998 0.986-1.009 0.692 D-dimer 1.045 0.905-1.206 0.549 Creatinine 1.002 0.999-1.004 0.178 Fibrinogen 1.072 0.880-1.307 0.489 AST 1.000 0.997-1.002 0.885 ALT 1.006 0.998-1.014 0.140 LDL 1.377 1.107-1.712 0.004 HDL 0.216 0.092-0.509 < 0.001 TC 1.184 1.011-1.386 0.036 LVEDD 1.020 0.979-1.062 0.352 EF 1.007 0.983-1.032 0.548 Emergency PCI 0.882 0.584-1.333 0.552 TC/HDL 2.332 1.847-2.944 < 0.001 Multivariable analysis TC: model 1 0.542 0.286-1.029 0.061 HDL: model 2 0.044 0.014-0.137 < 0.001 TC/HDL: model 3 2.529 1.909-3.352 < 0.001 Model 1, 2, 3 adjusted for sex, age, smoking status, hypertension, DM, LDL, respectively. Abbreviation: MACEs: Major adverse cardiovascular events; HR: Hazard ratio; CI: Confidence interval; DM: Diabetes Mellitus; WBC: White blood cell; AST: Aspartate Transaminase; ALT: Alanine Aminotransferase; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; TC: Total cholesterol; LVEDD: Left ventricular end-diastolic diameter; EF: Ejection fraction; PCI: Percutaneous Coronary Intervention. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 21 Apr, 2026 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 13 Feb, 2026 Reviews received at journal 17 Jan, 2026 Reviewers agreed at journal 13 Jan, 2026 Reviewers agreed at journal 12 Jan, 2026 Reviews received at journal 09 Jan, 2026 Reviewers agreed at journal 07 Jan, 2026 Reviewers invited by journal 07 Jan, 2026 Editor invited by journal 26 Dec, 2025 Editor assigned by journal 24 Dec, 2025 Submission checks completed at journal 24 Dec, 2025 First submitted to journal 21 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8417160","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":571737635,"identity":"3d9e4c0b-5593-443c-9e53-b838328d947b","order_by":0,"name":"Xin Zhang","email":"","orcid":"","institution":"Liaocheng People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xin","middleName":"","lastName":"Zhang","suffix":""},{"id":571737636,"identity":"8fb4dd58-4368-4205-9639-1ae0af3cfbf7","order_by":1,"name":"Wei Wang","email":"","orcid":"","institution":"Liaocheng People's 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07:10:45","extension":"xml","order_by":19,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100872,"visible":true,"origin":"","legend":"","description":"","filename":"8c8e2e5358be46d8a541e4985243f73b1structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/ad30fd958053cfd313d5467b.xml"},{"id":100017598,"identity":"6da9bfaf-a910-4986-8bac-bbb8f808435a","added_by":"auto","created_at":"2026-01-12 07:10:45","extension":"html","order_by":20,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":109379,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/6729f4ae271f31fc16fc78ca.html"},{"id":100362155,"identity":"42f6eebd-f11f-4cac-88f4-9785a50e51f1","added_by":"auto","created_at":"2026-01-16 07:46:14","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":234633,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe level of TC/HDL was compared between MACEs and non-MACEs groups.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTC: Total cholesterol; HDL: High-density lipoprotein; MACEs: Major adverse cardiovascular events.\u003c/p\u003e","description":"","filename":"Fig.1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/a2b37e32a9f5182432229d72.jpg"},{"id":100362507,"identity":"bd964a99-8851-47db-b3aa-6ba9d460c852","added_by":"auto","created_at":"2026-01-16 07:46:55","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":621424,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCorrelation of TC/HDL ratio and clinical characteristics.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTC: Total cholesterol; HDL: High-density lipoprotein; LDL: Low-density lipoprotein.\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/c74652ec3d30669816096646.jpg"},{"id":100362107,"identity":"779aa932-d22e-487f-903c-e52154ad15b0","added_by":"auto","created_at":"2026-01-16 07:46:11","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":155392,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKaplan-Meier survival curves of TC/HDL ratio in AMI patients during follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTC: Total cholesterol; HDL: High-density lipoprotein; MACEs: Major adverse cardiovascular events.\u003c/p\u003e","description":"","filename":"Fig.3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/b55ea3ea24119b3ffde9268b.jpg"},{"id":100017588,"identity":"c6b41d7f-334a-4bdb-8559-6314e623a429","added_by":"auto","created_at":"2026-01-12 07:10:45","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":307511,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eThe ROC curves of TC/HDL ratio and HDL in the prediction of MACEs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eROC: Receiver operating characteristic; TC: Total cholesterol; HDL: High-density lipoprotein.\u003c/p\u003e","description":"","filename":"Fig.4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/06512cc534fbd6e3139fb771.jpg"},{"id":107928324,"identity":"c5c333db-80e2-4528-959a-b927ef46433f","added_by":"auto","created_at":"2026-04-27 16:10:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1699707,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8417160/v1/2d0ad41d-43a7-4dce-a6e8-9238e9327944.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The predictive value of TC/HDL ratio in patients with acute myocardial infarction undergoing PCI","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAcute myocardial infarction (AMI) remains a leading cause of morbidity and mortality worldwide. As a life-threatening coronary event, AMI can lead to sudden cardiac death (SCD) and represents the most severe clinical manifestation of coronary artery disease (CAD). AMI is classified into two main types: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Complications following infarction include heart failure (HF), cardiac rupture, arrhythmias, ventricular septal rupture, and cardiogenic shock [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although the incidence of post-AMI complications has declined with the use of reperfusion techniques, this disease continues to impose a substantial burden on human health. Therefore, early identification of predictors for these complications in AMI is urgently needed to reduce mortality.\u003c/p\u003e \u003cp\u003eHigh-density lipoprotein (HDL) is known for its anti-inflammatory and antioxidant properties, which help protect cardiomyocytes from oxidative stress and may slow the progression of coronary artery stenosis. Conversely, elevated total cholesterol (TC) levels are implicated in promoting inflammation and oxidative stress, thereby increasing the risk of cardiovascular diseases (CVD). The TC/HDL ratio, a widely used marker of lipid metabolism, reflects the overall balance of cholesterol. By integrating the protective effects of HDL with the atherogenic potential of TC, it provides a more comprehensive cardiovascular risk profile than individual lipid parameters, establishing its value as an indicator in cardiovascular and metabolic research [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMany studies have investigated the relationship between serum TC/HDL ratio and metabolic diseases such as ischemic heart disease (IHD), micronutrients intakes, osteoporosis and premature myocardial infarction [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], but the relationship between the TC/HDL ratio and the prognosis of AMI patients is unclear. Therefore, the present study aimed to investigate the predictive value of preprocedural TC/HDL ratio for major adverse cardiovascular events (MACEs) in AMI patients undergoing percutaneous coronary intervention (PCI). These findings could inform more effective risk assessment and management strategies, thereby helping to reduce the global burden of cardiovascular disease.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy design and participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this retrospective study, the study population comprised 398 patients admitted to the Department of Cardiology of Liaocheng People\u0026apos;s Hospital from October 2023 to July 2024, all of whom were diagnosed with AMI and subsequently underwent PCI. The diagnosis of AMI was based on the Fourth Universal Definition of Myocardial Infarction (2018) [9]. Patients with malignant tumors, liver and kidney failure, immune diseases, mental diseases and other diseases affecting their lives were excluded from our study.\u0026nbsp;This study was conducted in accordance with the Declaration of Helsinki (1989) and was approved by the Ethics Committee of Liaocheng People\u0026apos;s Hospital. The requirement for written informed consent was waived, due to the analysis used anonymized retrospective data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical data collection\u0026nbsp;and follow-up of\u0026nbsp;patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData on baseline characteristics and past medical history, such as sex, age, smoking status, family history of CAD, hypertension, and diabetes mellitus (DM), were collected from the hospital medical record system and follow-up records. Venous blood samples were collected from all patients prior to PCI and sent to the hospital\u0026apos;s central laboratory for analysis. Measurements included total cholesterol (TC), high-density lipoprotein (HDL), transaminase, creatinine, and other relevant parameters, following standard laboratory procedures. Following the procedure, all patients received conventional evidence-based medical therapy for CAD. This included dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor, lipid-lowering agents such as statins, and other indicated treatments.\u003c/p\u003e\n\u003cp\u003ePatients were followed up for 6 months after discharge via telephone interviews or medical record reviews. The occurrences of MACEs were recorded. A total of 28 patients were lost to follow-up and excluded, resulting in a final cohort of 398 AMI patients who completed the study for evaluation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDefinitions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe endpoint of this study was the occurrence of MACEs, including malignant arrhythmia, all-cause death, new-onset HF, angina, and re-infarction.\u003c/p\u003e\n\u003cp\u003eMalignant arrhythmia was identified by electrocardiogram or Holter monitoring. Death was defined as all-cause mortality. The diagnosis of new-onset HF was based on clinical signs and symptoms, supported by findings from physical examination, echocardiography, or chest X-ray. Angina or re-infarction was diagnosed according to ischemic symptoms accompanied by electrocardiographic changes, with or without elevated serum cardiac enzyme levels.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were performed using SPSS software (version 29.0; IBM Corp.). Continuous variables were assessed for normality with the Shapiro-Wilk test. Normally distributed data are presented as mean \u0026plusmn; standard deviation and compared using the independent samples \u003cem\u003et\u003c/em\u003e-test. Non-normally distributed data are expressed as median (interquartile range, IQR) and compared with the Mann-Whitney \u003cem\u003eU\u003c/em\u003e test. Categorical variables are summarized as frequency (percentage) and compared using the chi-square (\u003cem\u003e\u0026chi;\u0026sup2;\u003c/em\u003e) test.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; Univariate logistic regression was performed to identify factors associated with MACEs, with variables yielding a p-value \u0026lt; 0.05 being included in the subsequent multivariate model. The predictive performance of the TC/HDL ratio was assessed using receiver operating characteristic (ROC) curve analysis, and the optimal cutoff value was determined by maximizing Youden\u0026apos;s index. Short-term event-free survival (EFS) was analyzed with the Kaplan-Meier method and compared using the log-rank test. A two-sided p-value \u0026lt; 0.05 was considered statistically significant for all analyses.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics of the patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 398 AMI patients who underwent PCI were enrolled in this study, including 295 male patients and 103 female patients. Patients were divided into two groups based on median TC/HDL ratio levels: a high TC/HDL ratio group (TC/HDL\u0026ge;4.13; n=199) and a low TC/HDL ratio group (TC/HDL\u0026lt;4.13; n=199). The high TC/HDL ratio group patients were younger, had higher levels of hemoglobin, white blood cell, platelet, albumin, TC, LDL, triglyceride (TG) and lower HDL levels. The difference between the two groups was detailed in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatients were categorized into two groups based on the occurrence of MACEs: the MACEs group (n=101) and the non-MACEs group (n=297). As shown in Table 2, compared to the non-MACEs group, patients in the MACEs group were younger and had a higher prevalence of males, smoking, hypertension, DM, family history of CAD, and emergency PCI. They also exhibited significantly higher levels of hemoglobin, platelets, creatinine, albumin, TC, LDL, and TG, but lower levels of HDL.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe levels of TC/HDL ratio in MACEs and non-MACEs groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs shown in Figure 1, the TC/HDL ratio was significantly higher in the MACEs group compared to the non-MACEs group (p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation of TC/HDL ratio and clinical characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTC/HDL ratio levels were positively correlated with LDL levels (r=0.631, p\u0026lt;0.001; Figure 2a); platelet levels (r=0.175, p\u0026lt;0.001; Figure 2b); hemoglobin levels (r=0.203, p\u0026lt;0.001; Figure 2c); and TG levels (r=0.381, p\u0026lt;0.001; Figure 2d). While, TC/HDL ratio levels were negatively correlated with age (r=-0.196, p\u0026lt;0.001; Figure 2e). However, no significant correlation was found between the TC/HDL ratio and ejection fraction (r=0.023, p=0.642; Figure 2f). Similarly, the ratio was not correlated with fibrinogen (r=0.075, p=0.135; Figure 2g) or D-dimer levels (r=0.042, p=0.400; Figure 2h).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical outcomes of MACEs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe incidence of MACEs was 25.4% (101 out of 398 patients), including death (n=1), angina or re-infarction (n=82), malignant arrhythmia (n=3), and new-onset HF (n=15). The total MACEs rate was significantly higher in the high TC/HDL ratio group compared to the low ratio group (42.7% vs. 8.0%, p\u0026lt;0.001). Furthermore, the incidence of angina or reinfarction and new-onset HF between the two groups was statistically significant (both p\u0026lt;0.001). However, there were no significant differences in the incidence of death or malignant arrhythmia between the two groups (as shown in Table 3).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIndependent predictors for MACEs in AMI patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs demonstrated in Table 4, potential confounders associated with MACEs were analyzed using univariate analysis. Variables with p-value \u0026lt;0.05 in univariate analysis were included in multivariate Cox regression analysis. After adjusting for gender, age, smoking, hypertension, DM, LDL levels, and TC/HDL ratio level [adjusted hazard ratio (HR): 2.529, 95% confidence interval (CI): 1.909-3.352; p\u0026lt;0.001] was identified as a significant positive independent predictor of MACEs. In addition, HDL level (adjusted HR: 0.044, 95% CI: 0.014-0.137; p\u0026lt;0.001)\u0026nbsp;was also an independent predictor of MACEs. While, TC level (adjusted HR: 0.542, 95% CI: 0.286-1.029; p=0.061) was not.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKaplan-Meier survival curves of TC/HDL ratio in AMI patients during follow-up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKaplan-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\u0026lt;0.001) (Figure 3). As a result, patients with lower TC/HDL levels have a better prognosis than those with high TC/HDL levels.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eROC curve to evaluate the predictive value of TC/HDL ratio for MACEs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo test the performance of TC/HDL ratio in predicting MACEs, ROC curve analysis was conducted. The AUC values for TC/HDL ratio were 0.748 (95% CI: 0.698-0.798; p\u0026lt;0.001) with 89.1% sensitivity and 58.9% specificity (Figure 4a). The AUC values for HDL were 0.618 (95% CI: 0.554-0.682; p\u0026lt;0.001) with 81.1% sensitivity and 37.6% specificity (Figure 4b).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eWhile advancements in PCI have improved outcomes for AMI patients, long-term prognosis and the risk of MACEs remain a critical concern. This study demonstrates that the TC/HDL ratio is a significant predictor of MACEs in AMI patients undergoing PCI. ROC curve analysis confirmed its robust predictive value, highlighting its potential utility in risk stratification.\u003c/p\u003e \u003cp\u003eLDL is the principal atherogenic component of TC, which also includes HDL and VLDL. Elevated LDL levels are an established independent risk factor for CVD, as LDL promotes atherosclerosis and thrombosis through multiple mechanisms. Consequently, authoritative international guidelines, such as those from the ACC/AHA, unequivocally endorse LDL-lowering as a fundamental strategy in the management of atherosclerotic cardiovascular disease (ASCVD). HDL levels are well-established to correlate with a reduced risk of cardiovascular events [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The underlying mechanism centers on reverse cholesterol transport, a process whereby HDL mediates cholesterol removal from peripheral tissues. This mechanism not only reduces the accumulation of atherogenic apolipoprotein B in the arterial wall to facilitate cholesterol efflux from plaques but also triggers an influx of phagocytic cells that clear necrotic material, thereby promoting plaque stabilization [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Previous studies indicate that HDL promotes endothelial homeostasis by enhancing nitric oxide (NO) production and suppressing key pathways involved in vascular inflammation and apoptosis [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, this protective function of HDL is compromised in patients with CAD, manifesting as an impaired ability to stimulate NO generation and support endothelial repair [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Venkat et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] demonstrated that HDL levels are inversely correlated with fibrous, fibrous fatty, total non-calcified plaque, and total plaque volume. TC/HDL ratio has been reported as a risk indicator with greater predictive value than isolated parameters, particularly LDL [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Therefore, the TC/HDL ratio reflects the cholesterol balance between atherogenic and anti-atherogenic lipoprotein particles.\u003c/p\u003e \u003cp\u003eMany previous studies have evaluated the association between cholesterol levels and CVD risk, both in elderly and younger populations [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In our study, multivariable Cox analysis showed that TC was not a meaningful predictor of MACEs after adjusting for confounding factors (p\u0026thinsp;=\u0026thinsp;0.061). Future studies including larger sample sizes and extended follow-up may further clarify the significance of TC in MACEs. Low HDL levels are associated with an increased incidence of cardiovascular mortality and recurrent MI [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Conversely, high HDL levels may correlate with a reduced risk of cardiovascular events, particularly in STEMI patients, suggesting a potential protective effect [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In our study, the AUC values for HDL were 0.618, indicated that the HDL had a predictive value for MACEs in this population. However, some studies revealed that increasing HDL levels may not reduce future cardiovascular events or atherosclerotic burden [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. It is increasingly appreciated that the metabolism and regulation of HDL are far more complex than once understood, being highly dynamic and subject to context-dependent modification, notably during the progression of various disease states [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The relationship between HDL and CVD risk and prognosis remains controversial, and further mechanism and clinical studies are needed.\u003c/p\u003e \u003cp\u003eIn a cohort study of middle-aged women with a mean follow-up of 17 years, researchers found a strong association with IHD for TC/HDL ratio, they found that TC/HDL had a slightly higher predictive ability for IHD than non-HDL [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, the results of a prospective cohort study involving 34294 participants showed a significant positive correlation between TC/HDL ratio and stroke occurrence [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The results mentioned above align with our research outcomes. Another study by Zhou et al. [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] demonstrated that the TC/HDL ratio\u0026thinsp;\u0026gt;\u0026thinsp;4.22 had higher cardiovascular mortality. Moreover, people with TC/HDL at 4.0, there was 55.2% and 24.0% increased risks of CVD hospitalization within 2 years and rehospitalization after 90 days of prior CVD hospitalization comparing patients with TC/HDL at 2.8, respectively [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In our study, an elevated TC/HDL ratio was associated with an increased incidence of MACEs. Our subgroup analysis confirmed that patients who experienced MACEs had a significantly higher TC/HDL ratio compared to those in the non-MACEs group. Furthermore, the incidences of angina, reinfarction, and new-onset HF were all significantly greater in the MACEs group, which is consistent with findings from previous studies. The incidence of death or malignant arrhythmia, however, was not significantly different between the groups. According to Kaplan-Meier survival analysis, a lower TC/HDL level was associated with a better prognosis, suggesting its prognostic utility. This was further supported by ROC curve analysis, which indicated that the TC/HDL ratio (AUC: 0.748) had a better predictive value for MACEs than HDL alone (AUC: 0.618).\u003c/p\u003e \u003cp\u003eThis study has several notable limitations. First, the findings are constrained by a relatively short follow-up duration and a limited sample size. Second, the male predominance in our cohort (2.9:1) may introduce gender bias and precludes the generalizability of the results to the female population. Finally, as this was a single-center study involving an AMI population from northern China, the findings may not be fully representative of other demographic or geographic groups within China. Future studies with longer follow-up, larger and more balanced cohorts, and multi-center designs are warranted to validate our conclusions.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eHigh TC/HDL ratio levels are associated with the development of MACEs in patients with AMI undergoing PCI, which providing additional information to the commonly used clinical markers.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the patients, nurses, study coordinators and all investigators involved in this study, without whom the study would not have been possible.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTL put forward conception and study design. WW, LX and NS researched data. XZ wrote the manuscript and contributed to statistical analysis. XZ and TL edited and contributed to the manuscript, data interpretation, and discussion. All authors have read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by\u0026nbsp;the \u0026ldquo;Key R\u0026amp;D Program of Liaocheng City\u0026rdquo; (2024YD36).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome or all datasets analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and informed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by the Local Ethics Committee of the Liaocheng People\u0026apos;s Hospital. The requirement for written informed consent was waived, due to the analysis used anonymized retrospective data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSalari N, Morddarvanjoghi F, Abdolmaleki A, Rasoulpoor S, Khaleghi AA, Hezarkhani LA, et al. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023; 23(1):206.\u003c/li\u003e\n\u003cli\u003eSanchez-Jimenez E, Fanne RA, Levi Y, Saada M, Kobo O, Roguin A. Predictors, Outcomes and Impact of Mechanical Circulatory Support of Patients With Mechanical Complications After Acute Myocardial Infarction. Cardiovasc Revasc Med. 2023; 52:23-9.\u003c/li\u003e\n\u003cli\u003eAl-Naabi MJ, Maddali MM, Venkatachlam R. Mechanical Complication After a Myocardial Infarction. J Cardiothorac Vasc Anesth. 2021; 35(2):670-2.\u003c/li\u003e\n\u003cli\u003eFrampton J, Ortengren AR, Zeitler EP. Arrhythmias After Acute Myocardial Infarction. Yale J Biol Med. 2023; 96(1):83-94.\u003c/li\u003e\n\u003cli\u003eBagger YZ, Rasmussen HB, Alexandersen P, Werge T, Christiansen C, Tanko LB, et al. Links between cardiovascular disease and osteoporosis in postmenopausal women: serum lipids or atherosclerosis per se? Osteoporos Int. 2007; 18(4):505-12.\u003c/li\u003e\n\u003cli\u003eZhao C, Zhang X, Zhang X, Zhao B, Yang Y, Lin M, et al. U-shaped association between TC/HDL-C ratio and osteoporosis risk in older adults. 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N Engl J Med. 2007; 357(13):1301-10.\u003c/li\u003e\n\u003cli\u003eVoight BF, Peloso GM, Orho-Melander M, Frikke-Schmidt R, Barbalic M, Jensen MK, et al. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. Lancet. 2012; 380(9841):572-80.\u003c/li\u003e\n\u003cli\u003eYang Y, Zhang J, Jia L, Su J, Ma M, Lin X. The interaction between uric acid and high-density lipoprotein cholesterol on the prognosis of patients with acute myocardial infarction. Front Cardiovasc Med. 2023; 10:1226108.\u003c/li\u003e\n\u003cli\u003eTrimarco V, Izzo R, Morisco C, Mone P, Virginia Manzi M, Falco A, et al. High HDL (High-Density Lipoprotein) Cholesterol Increases Cardiovascular Risk in Hypertensive Patients. Hypertension. 2022; 79(10):2355-63.\u003c/li\u003e\n\u003cli\u003eTang M, Zhao Q, Yi K, Wu Y, Xiang Y, Cui S, et al. Association between four nontraditional lipids and ischemic stroke: a cohort study in Shanghai, China. Lipids Health Dis. 2022; 21(1):72.\u003c/li\u003e\n\u003cli\u003eZhou D, Liu X, Lo K, Huang Y, Feng Y. The effect of total cholesterol/high-density lipoprotein cholesterol ratio on mortality risk in the general population. Front Endocrinol (Lausanne). 2022; 13:1012383.\u003c/li\u003e\n\u003cli\u003eYu D, Cai Y, Qin R, Graffy J, Holman D, Zhao Z, et al. Total/high density lipoprotein cholesterol and cardiovascular disease (re)hospitalization nadir in type 2 diabetes. J Lipid Res. 2018; 59(9):1745-50.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Basic characteristics of studied patients according to TC/HDL levels.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"521\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eHigh TC/HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eLow TC/HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003en = 199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003en = 199\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e61 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e63.7 \u0026plusmn; 10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;gender, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e153 (76.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e142 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eSmoking, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e97 (48.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e104 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHypertension, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e110 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e119 (59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eDM, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e65 (37.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e48 (24.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFamily history, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e17 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e18 (9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.860\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNeutrophil percentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e70.2 (17.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e69.81 \u0026plusmn; 12.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHemoglobin\u0026nbsp;(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e139.15\u0026nbsp;\u0026plusmn; 16.85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e134.67 \u0026plusmn; 16.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eWBC count (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e8.43 (4.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8.01 (3.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003ePlatelet (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e244.1\u0026nbsp;\u0026plusmn; 51.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e222 (69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eD-dimer (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0.30 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.27 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFibrinogen (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3.13 (1.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e3.08 (0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eCreatinine (umol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e63.0\u0026nbsp;\u0026plusmn; 22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e62.6 (23.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.817\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAlbumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e41 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e39 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eTG (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.53 (1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.04 (0.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.09\u0026nbsp;\u0026plusmn; 0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.21\u0026nbsp;\u0026plusmn; 0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eLDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3.40\u0026nbsp;\u0026plusmn; 0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2.59\u0026nbsp;\u0026plusmn; 0.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eTC (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e5.2 (1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.24\u0026nbsp;\u0026plusmn; 1.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e25 (17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e25 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.791\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e33 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.793\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e52 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e52 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eLVEDD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e46 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e45 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eEmergency PCI, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e69 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e57 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.196\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: TC: Total cholesterol; HDL: High-density lipoprotein; DM: Diabetes mellitus; WBC: White blood cell; TG: Triglyceride; LDL: Low-density lipoprotein; ALT: Alanine aminotransferase; AST: Aspartate transaminase; EF: Ejection fraction; LVEDD: Left ventricular end-diastolic diameter; PCI: Percutaneous coronary Intervention.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2. Basic characteristics of studied patients according to MACEs or non-MACEs.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"521\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 171px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eMACEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003eNon-MACEs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003en = 101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003en = 297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAge\u0026nbsp;(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e61 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e63 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eMale\u0026nbsp;gender, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e85 (84.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e210 (70.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eSmoking, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e66 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e135 (45.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHypertension, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e71 (70.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e158 (53.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eDM, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e41 (40.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e72 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFamily history, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e18 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e17 (5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eNeutrophil percentage (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e68.5 \u0026plusmn; 11.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e71.2 (17.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.135\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHemoglobin\u0026nbsp;(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e142\u0026nbsp;(24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e135.5 \u0026plusmn;16.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.003\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eWBC count (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e8.95 \u0026plusmn; 2.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e8.06 (3.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.185\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003ePlatelet (\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e245.6 \u0026plusmn; 60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e227 (74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.042\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eD-dimer (mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e0.30 (0.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e0.28 (0.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eFibrinogen (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3.19 (1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e3.08 (0.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.362\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eCreatinine (umol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e67.4 (25.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e61.9 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAlbumin (g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e41.55\u0026nbsp;\u0026plusmn; 4.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e39 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eTG (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.44 (1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.16 (0.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eHDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e1.08\u0026nbsp;\u0026plusmn; 0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e1.16 (0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eLDL (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e3.21\u0026nbsp;\u0026plusmn; 0.71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e2.92\u0026nbsp;\u0026plusmn; 0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eTC (mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e4.94\u0026nbsp;\u0026plusmn; 1.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e4.65\u0026nbsp;\u0026plusmn; 1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eALT (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e28 (19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e24 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eAST (U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e32 (34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e32 (41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.708\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eEF (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e52 (13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e52 (14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.589\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eLVEDD (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e46 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e46 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 171px;\"\u003e\n \u003cp\u003eEmergency PCI, n\u0026nbsp;(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e69 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e57 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviation: MACEs: Major adverse cardiovascular events; DM: Diabetes mellitus; WBC: White blood cell; TG: Triglyceride; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; TC: Total cholesterol; ALT: Alanine aminotransferase; AST: Aspartate transaminase; EF: Ejection fraction; LVEDD: Left ventricular end-diastolic diameter; PCI: Percutaneous coronary Intervention.\u003c/p\u003e\n\u003cp\u003eTable 3. Major adverse cardiac events according to TC/HDL ratio\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003eHigh TC/HDL ratio\u003c/p\u003e\n \u003cp\u003e(n = 199)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003eLow TC/HDL ratio\u003c/p\u003e\n \u003cp\u003e(n = 199)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eDeath, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e0\u0026nbsp;(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eAngina\u0026nbsp;or MI, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e68\u0026nbsp;(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e14\u0026nbsp;(7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eHeart failure, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e15\u0026nbsp;(7.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e0\u0026nbsp;(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eMalignant arrhythmia, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e2\u0026nbsp;(1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e1\u0026nbsp;(0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 180px;\"\u003e\n \u003cp\u003eTotal MACEs, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 151px;\"\u003e\n \u003cp\u003e85\u0026nbsp;(42.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 173px;\"\u003e\n \u003cp\u003e16\u0026nbsp;(8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 73px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eAbbreviation: TC:\u0026nbsp;Total cholesterol;\u0026nbsp;HDL: High-density lipoprotein;\u0026nbsp;MI: myocardial infarction; MACEs:\u003c/p\u003e\n\u003cp\u003eMajor adverse cardiac events.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4. Cox proportional hazard analysis for predictors of MACEs.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003eHR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cem\u003ep\u0026nbsp;\u003c/em\u003evalue\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.989\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.166-3.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.961-0.994\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eSmoking status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e2.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.343-3.048\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e2.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.312-3.083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e2.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.401-3.104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003ePlatelet\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e1.000-1.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eWBC count\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.986-1.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.692\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eD-dimer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.905-1.206\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eCreatinine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.999-1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.178\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eFibrinogen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.880-1.307\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.997-1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.885\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 172px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e1.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e0.998-1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 80px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 172px;\"\u003e\n \u003cp\u003eLDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 125px;\"\u003e\n \u003cp\u003e1.377\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e1.107-1.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 188px;\"\u003e\n \u003cp\u003eHDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e0.216\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.092-0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eTC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.011-1.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eLVEDD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.979-1.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eEF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.983-1.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.548\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eEmergency PCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.882\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.584-1.333\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.552\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eTC/HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e2.332\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e1.847-2.944\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eMultivariable analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 117px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eTC: model 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.286-1.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e0.061\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 188px;\"\u003e\n \u003cp\u003eHDL: model 2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 117px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 144px;\"\u003e\n \u003cp\u003e0.014-0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 188px;\"\u003e\n \u003cp\u003eTC/HDL: model 3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 117px;\"\u003e\n \u003cp\u003e2.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1.909-3.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 138px;\"\u003e\n \u003cp\u003e\u0026lt; 0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel 1, 2, 3 adjusted for sex, age, smoking status, hypertension, DM, LDL, respectively. Abbreviation: MACEs: Major adverse cardiovascular events; HR: Hazard ratio; CI: Confidence interval; DM: Diabetes Mellitus; WBC: White blood cell; AST: Aspartate Transaminase; ALT: Alanine Aminotransferase; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; TC: Total cholesterol; LVEDD: Left ventricular end-diastolic diameter; EF: Ejection fraction; PCI: Percutaneous Coronary Intervention.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"TC/HDL, AMI, PCI, MACEs, Predictive Value","lastPublishedDoi":"10.21203/rs.3.rs-8417160/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8417160/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eTotal cholesterol to high-density lipoprotein (TC/HDL) ratio was yet to be discovered 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.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e398 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.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe 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): 2.529, 95% confidence interval (CI): 1.909\u0026ndash;3.352; p\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eTC/HDL ratio levels have strong ability for MACEs in patients with AMI undergoing PCI, which providing additional information to the commonly used clinical markers.\u003c/p\u003e","manuscriptTitle":"The predictive value of TC/HDL ratio in patients with acute myocardial infarction undergoing PCI","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-12 07:10:40","doi":"10.21203/rs.3.rs-8417160/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-13T08:14:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-17T06:56:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"55443121895392763167988234448451023192","date":"2026-01-13T05:54:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"133268509097785679761133742389120708298","date":"2026-01-12T07:21:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-09T21:48:53+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"76681260456429483401289714774543297360","date":"2026-01-08T04:42:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-08T01:49:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-12-26T06:13:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-24T09:45:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-24T09:45:19+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2025-12-21T12:07:40+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3497629f-d33d-40d7-8c79-7a4a12a433a2","owner":[],"postedDate":"January 12th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T16:08:01+00:00","versionOfRecord":{"articleIdentity":"rs-8417160","link":"https://doi.org/10.1186/s12872-026-05862-1","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2026-04-21 15:57:56","publishedOnDateReadable":"April 21st, 2026"},"versionCreatedAt":"2026-01-12 07:10:40","video":"","vorDoi":"10.1186/s12872-026-05862-1","vorDoiUrl":"https://doi.org/10.1186/s12872-026-05862-1","workflowStages":[]},"version":"v1","identity":"rs-8417160","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8417160","identity":"rs-8417160","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}