Cholesterol–HDL–glucose index and short- and long-term mortality after acute myocardial infarction: a clinical cohort study with supportive MIMIC-IV replication

Q: What are the key findings of this study?

The highest quartile of the cholesterol-HDL-glucose index was associated with a significantly increased risk of 30-day mortality (HR 2.76) compared to the lowest quartile in patients with acute myocardial infarction.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Myocardial Infarction (n=5187). Intervention: Cholesterol-HDL-Glucose (CHG) index vs. Lowest CHG quartile. Primary outcome: 30-day all-cause mortality (HR 2.76, 95% CI 1.57-4.86, p=<0.001).

Q: What does this research mean for the field?

The highest quartile of the cholesterol-HDL-glucose (CHG) index is associated with a significantly increased risk of 30-day mortality compared to the lowest quartile in patients with acute myocardial infarction, providing complementary prognostic information to the GRACE score. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the association between the cholesterol–HDL–glucose (CHG) index and 30-day and 365-day mortality after acute myocardial infarction, and evaluate its prognostic performance relative to standard metabolic markers and the GRACE risk score.

Yanlong Zhao; Mengtao Zheng; Zhi Liu

doi:10.1186/s12902-026-02487-5

August 19, 2026BMC Endocrine DisordersOpen Access

Cholesterol–HDL–glucose index and short- and long-term mortality after acute myocardial infarction: a clinical cohort study with supportive MIMIC-IV replication

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Key result

Top cholesterol-HDL-glucose index quartile linked to ~176% higher 30-day mortality in AMI patients.

HR 2.76
95% CI 1.57-4.86
P<0.001
n=5,187

Why the study?

The prognostic relevance of the cholesterol-HDL-glucose index during acute myocardial infarction remains uncertain.

Does an elevated cholesterol-HDL-glucose (CHG) index predict increased 30-day and 365-day mortality in patients with acute myocardial infarction?

Key Points

To assess the association between the cholesterol–HDL–glucose (CHG) index and 30-day and 365-day mortality after acute myocardial infarction, and evaluate its prognostic performance relative to standard metabolic markers and the GRACE risk score.
Retrospective two-cohort study evaluating 4,167 patients with acute myocardial infarction in a primary clinical cohort and 1,020 ICU patients in a supportive MIMIC-IV replication cohort.
CHG index was modeled continuously and divided into clinical-cohort quartiles (Q1 to Q4), with the upper-quartile cutoff (5.818) applied to the MIMIC-IV cohort.
Associations with 30-day and 365-day all-cause mortality were evaluated using multivariable Cox proportional hazards regression, restricted cubic splines, time-dependent ROC curves, and nested comparisons with GRACE.
In the primary clinical cohort, 138 patients (3.3%) died within 30 days and 196 (4.7%) within 365 days; fully adjusted HRs for Q4 versus Q1 were 2.76 (95% CI, 1.57–4.86; P < 0.001) for 30-day mortality and 2.40 (95% CI, 1.50–3.86; P < 0.001) for 365-day mortality.
Per 1-unit increase in CHG in the clinical cohort, the fully adjusted HR was 2.16 (95% CI, 1.54–3.02; P < 0.001) for 30-day mortality and 1.88 (95% CI, 1.41–2.51; P < 0.001) for 365-day mortality, providing superior discrimination over the TyG index (30-day AUC 0.658 vs 0.598, P < 0.001; 365-day AUC 0.621 vs 0.574, P = 0.001) and improving fit when added to GRACE.
In the MIMIC-IV replication cohort, 150 patients (14.7%) died within 30 days and 268 (26.3%) within 365 days; high CHG was associated with 30-day mortality in a fixed-horizon logistic model (OR 1.60; 95% CI, 1.02–2.52; P = 0.041; Cox HR 1.41; 95% CI, 0.98–2.04; P = 0.066), but no 365-day association was observed (HR 1.00; 95% CI, 0.76–1.32; P = 0.977).

Study Design

Type

Cohort (n=5,187)

Multicenter

Yes

Structured PICO

Does an elevated cholesterol-HDL-glucose (CHG) index predict increased 30-day and 365-day mortality in patients with acute myocardial infarction?

P

Population

5,187 adult patients with acute myocardial infarction from a primary clinical cohort and a supportive ICU replication cohort, followed for up to 365 days.

E

Exposure

Elevated cholesterol-HDL-glucose (CHG) index (highest quartile or ≥5.818)

C

Comparator

Lower cholesterol-HDL-glucose (CHG) index (lowest quartile or <5.818)

O

Outcome

30-day and 365-day all-cause mortalityhard clinical

Main Result

Hazard Ratio: 2.76 (95% CI 1.57–4.86)

p-value: p=<0.001

An elevated cholesterol-HDL-glucose (CHG) index is associated with increased 30-day and 365-day all-cause mortality in patients with acute myocardial infarction, providing complementary prognostic information to established risk scores like GRACE.

Limitations

Retrospective design precludes causal inference and leaves residual confounding, including from unavailable pre-admission lipid- and glucose-lowering therapies.
CHG was measured once at baseline or early during hospitalization, precluding evaluation of temporal changes.
Missing clinical-cohort covariates were imputed using a random-forest approach.
HDL-C was unavailable for 81.8% of otherwise eligible MIMIC-IV patients, limiting representativeness and generalizability.
Differences in illness severity, laboratory timing, and covariate availability limit direct comparability between cohorts.
Cardiogenic shock and acute left heart failure were sparsely recorded and potentially misclassified.
Retrospective design precludes causal inference and leaves residual confounding.

Implication

Elevated CHG index may aid AMI risk stratification; hypothesis-generating and requires prospective validation before practice change.

Abstract

The cholesterol–HDL–glucose (CHG) index integrates total cholesterol, HDL-C, and glucose, but its prognostic relevance during acute myocardial infarction (AMI) remains uncertain. We evaluated its associations with 30-day and 365-day mortality and compared its prognostic performance with conventional metabolic markers and GRACE. This retrospective two-cohort study included 4,167 clinical-cohort patients with AMI and 1,020 patients in a supportive MIMIC-IV replication cohort. CHG was modeled continuously and by clinical-cohort quartiles. The clinical-cohort upper-quartile cutoff was applied unchanged in MIMIC-IV as a grouping rule; cohort-specific models were fitted. Analyses included multivariable Cox regression, restricted cubic splines, subgroup and sensitivity analyses, time-dependent ROC, and nested GRACE comparisons. In the clinical cohort, the fully adjusted hazard ratios (HRs) for the highest versus lowest CHG quartile were 2.76 (95% CI, 1.57–4.86) for 30-day mortality and 2.40 (95% CI, 1.50–3.86) for 365-day mortality (both P < 0.001). The corresponding HRs per 1-unit increase were 2.16 (95% CI, 1.54–3.02) and 1.88 (95% CI, 1.41–2.51), respectively (both P < 0.001). CHG remained associated with both outcomes after accounting for GRACE, and adding CHG improved model fit. In MIMIC-IV, applying the clinical-cohort cutoff classified 40.6% of patients as high CHG. For 30-day mortality, the fully adjusted Cox estimate was HR 1.41 (95% CI, 0.98–2.04; P = 0.066), and the fixed-horizon logistic sensitivity estimate was OR 1.60 (95% CI, 1.02–2.52; P = 0.041). No significant 365-day association was observed in MIMIC-IV. Elevated CHG was associated with 30-day and 365-day mortality in the clinical AMI cohort and retained prognostic information alongside GRACE. As a readily calculable composite of routine glucose and lipid measurements, CHG may provide complementary information for metabolic risk assessment after AMI.

Discussion

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Cite This Study

Zhao et al. (2026) conducted a cohort in Acute Myocardial Infarction (n=5,187). Cholesterol-HDL-Glucose (CHG) index vs. Lowest CHG quartile was evaluated on 30-day all-cause mortality (HR 2.76, 95% CI 1.57-4.86, p=<0.001). The highest quartile of the cholesterol-HDL-glucose index was associated with a significantly increased risk of 30-day mortality (HR 2.76) compared to the lowest quartile in patients with acute myocardial infarction.

synapsesocial.com/papers/6a895eeeca7ade938187d2c3 https://doi.org/10.1186/s12902-026-02487-5

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Cholesterol–HDL–glucose index and short- and long-term mortality after acute myocardial infarction: a clinical cohort study with supportive MIMIC-IV replication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cholesterol–HDL–glucose index and short- and long-term mortality after acute myocardial infarction: a clinical cohort study with supportive MIMIC-IV replication

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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