Atherogenic and inflammatory biomarkers in NSTEMI: a comparative analysis of predictive value for obstructive coronary disease

Background The atherogenic index of plasma (AIP) and inflammatory indices may reflect the burden of atherosclerosis. This study evaluated their predictive value for obstructive coronary artery disease (CAD) in patients with non-ST-elevation myocardial infarction (NSTEMI).Methods This retrospective study included 624 NSTEMI patients undergoing coronary angiography. Patients were classified as having obstructive or non-obstructive CAD. Demographic, clinical, laboratory, and echocardiographic characteristics were compared. Independent predictors were identified using multivariable logistic regression, and discriminative performance was assessed by receiver operating characteristic analysis.Results The obstructive CAD group was significantly older (64.3 ± 12.3 vs. 57.4 ± 14.2 years; p < 0.001) with higher prevalence of males (63.3% vs. 50.8%; p = 0.003), hypertension (52.1% vs. 30.2%; p < 0.001), and diabetes mellitus (47.6% vs. 28.9%; p < 0.001). Inflammatory markers were markedly elevated: NLR [4.2 vs. 1.9; p < 0.001], PLR [140.9 vs. 119.1; p < 0.001], SII [1113.3 vs. 520.1; p < 0.001], and CRP [0.4 vs. 0.2 mg/dL; p < 0.001]. AIP was significantly higher [0.71 vs. 0.46; p < 0.001]. ROC analysis demonstrated that NLR (AUC = 0.764) and SII (AUC = 0.738) had the highest discriminative ability, while AIP showed limited performance (AUC = 0.563). In multivariable analysis, independent predictors included age (OR = 1.031), hypertension (OR = 1.645), diabetes (OR = 1.547), PLR (OR = 1.004), CRP (OR = 1.156), and AIP (OR = 2.413; all p < 0.05).Conclusion AIP was independently associated with obstructive CAD beyond traditional risk factors and inflammatory indices, despite modest standalone discriminative ability. These findings are hypothesis-generating and require prospective validation with clinical outcomes before routine clinical implementation.