Association between non-high-density lipoprotein cholesterol and high-density lipoprotein cholesterol ratio (NHHR) at 1 year after coronary artery bypass grafting and long-term outcomes in patients with multiple vessel disease: a retrospective cohort study

The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) has emerged as a promising lipid predictor for various cardiovascular conditions. However, its role in predicting long-term outcomes after coronary artery bypass grafting (CABG), particularly in multivessel disease (MVD) patients, remains unclear. We conducted a retrospective study of MVD patients who underwent CABG between 2011 and 2020. Patients were stratified into NHHR quartiles at baseline and 1-year post-CABG. The primary outcome was the incidence of major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiac death, myocardial infarction, stroke, repeat revascularization, and cardiac rehospitalization. Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to assess the relationship between NHHR and MACCEs. A total of 2,072 patients (mean age 60.8 ± 8.3 years; 83.5% male) were included. Over a median follow-up of 4.2 years, 25% experienced MACCEs. NHHR at baseline showed no significant association with MACCEs. However, NHHR at 1-year post-CABG was significantly associated with MACCEs. Compared to the first quartile, hazard ratios for MACCEs progressively increased in the second, third, and fourth quartiles (HR 1.16, 1.32, and 1.80, respectively; p < 0.01). RCS analysis confirmed a significant relationship between NHHR and MACCEs (p < 0.001). Multivariate Cox regression confirmed NHHR at 1-year post-CABG as an independent predictor of MACCEs. In patients with MVD undergoing CABG, NHHR at 1-year post-CABG independently predicts long-term MACCEs. Future studies are warranted to validate whether targeted lipid management based on NHHR can improve outcomes in this high-risk population.