Integrated metabolic-inflammatory risk assessment: HbA1c/HDL-c and hsCRP-to-albumin ratios synergistically predict major adverse cardiovascular events in post-PCI STEMI patients

BACKGROUND: This study looked into how predictive in ST-segment elevation myocardial infarction (STEMI) is the high-sensitivity C-reactive protein-to-albumin ratio (hsCAR) as well as glycated hemoglobin to high-density lipoprotein cholesterol (HbA1c/HDL-c) ratio. METHODS: This retrospective cohort research was carried out on 1,177 patients having STEMI who were given percutaneous coronary intervention (PCI). For major adverse cardiovascular events (MACE), the independent and combined predictive values of the HbA1c/HDL-c ratio (threshold ≥ 6.61) and hsCAR (threshold ≥ 0.18) were assessed. MACE was an amalgamation of death from all causes, ischemia-induced revascularization, myocardial infarction not leading to death, heart failure hospitalization, and cerebrovascular events. The team used Cox regression models, causal mediation examination, and receiver operating characteristic curves to assess prognostic performance and mechanistic pathways, and compared them with the Global Registry of Acute Coronary Events (GRACE) risk score. RESULTS: The interquartile range for follow-up was 79 to 672 days, with 461 median days. A raised HbA1c/HDL-c ratio (≥ 6.61) and hsCAR (≥ 0.18) independently predicted MACE, with 1.51 (95% confidence interval CI: 1.26-1.81; P < 0.001) as well as 1.84 (95% CI: 1.53-2.21; P = 0.005) hazard ratios (HRs), respectively. Combined use enhanced risk stratification, with the high HbA1c/HDL-c-high hsCAR group showing the highest risk (adjusted HR 2.19, 95% CI: 1.67-2.87; P < 0.001). Causal mediation examination revealed that coronary lesion complexity partially mediated these associations; the SYNergy between PCI with TAXUS and Cardiac Surgery (SYNTAX) and the residual SYNTAX scores were responsible for accounting for 24.2%/17.7% of the hsCAR effect and 16.8%/25.2% of the HbA1c/HDL-c ratio effect, respectively. Compared with the individual markers or the GRACE risk score, the combined biomarker model demonstrated superior discriminatory capacity (area under the curve = 0.63, 95% CI = 0.60-0.66; P < 0.001), with significant improvement in integrated discrimination. CONCLUSION: The integration of HbA1c/HDL-c and hsCAR can significantly improve risk stratification in patients with STEMI, outperforming traditional scoring systems and assisting in the precise management of individuals at risk.