Why the study?
Risk stratification in patients with ACS managed conservatively without revascularization remains challenging, prompting evaluation of the prognostic utility of the RDW-to-HDL-C ratio (RHR), RDW, and HDL-C.
Does the red cell distribution width-to-high-density lipoprotein cholesterol ratio (RHR) predict three-month major adverse cardiovascular events (MACE) in acute coronary syndrome patients managed conservatively without revascularization?
Cohort (n=82)
No
Does the red cell distribution width-to-high-density lipoprotein cholesterol ratio (RHR) predict three-month major adverse cardiovascular events (MACE) in acute coronary syndrome patients managed conservatively without revascularization?
In conservatively managed ACS patients, an elevated RDW-to-HDL-C ratio (≥0.375) is associated with 3-month MACE in unadjusted analysis (AUC = 0.699), but is not an independent predictor after multivariable adjustment, serving only as an exploratory prognostic marker.
Answers are grounded in this paper and cite their sources.
Should not guide risk stratification in conservatively managed ACS; leaves open independent prognostic value in larger adjusted cohorts.
Background and objectives. Risk stratification in patients with acute coronary syndrome (ACS) remains challenging, particularly in clinical settings where conservative management without revascularization is the primary treatment pathway. This study evaluated the prognostic utility of the red cell distribution width-to-high-density lipoprotein cholesterol ratio (RHR), red cell distribution width (RDW), and high-density lipoprotein cholesterol (HDL-C) in assessing outcomes among ACS patients managed conservatively. Materials and methods. A prospective cohort study was conducted between July and October 2024 at a tertiary referral hospital in Banda Aceh, Indonesia. Eighty-two ACS patients managed without revascularization were followed for three months to ascertain the development of major adverse cardiovascular events (MACE). Baseline RDW and lipid profiles were obtained to calculate RHR. Predictive performance was assessed using receiver operating characteristic (ROC) curves, and adjusted associations were examined using multivariable logistic regression. Results. MACE occurred in 47.6% (n = 39) of the cohort. An RHR cut-off of ≥0.375 demonstrated a moderate discriminatory area under the curve (AUC = 0.699). In unadjusted bivariate analysis, both elevated RHR and low HDL-C (<33.5 mg/dL) were significantly associated with higher odds of MACE (crude OR = 4.21, 95% CI: 1.62–10.97, p = 0.003; and crude OR = 3.69, 95% CI: 1.34–10.15, p = 0.011, respectively), whereas high RDW alone (≥14.85%) showed no significant association (crude OR = 2.62, p = 0.115). However, in multivariable logistic regression adjusting for RHR and HDL-C, these associations lost statistical significance (RHR adjusted OR = 2.66, 95% CI: 0.75–9.48, p = 0.132; HDL-C adjusted OR = 1.95, 95% CI: 0.57–6.64, p = 0.286). Conclusions. Elevated RHR is associated with three-month MACE in this conservatively managed ACS cohort. Although the adjusted association was not statistically significant in the multivariable model, RHR may represent a potentially useful, readily available exploratory prognostic marker.
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Ramadhan et al. (2026) conducted a cohort in Acute coronary syndrome managed conservatively without revascularization (n=82). Elevated red cell distribution width-to-high-density lipoprotein cholesterol ratio (RHR ≥ 0.375) vs. Low RHR (< 0.375) was evaluated on Three-month major adverse cardiovascular events (MACE: all-cause mortality, heart failure rehospitalization, recurrent myocardial infarction, or stroke) (Adjusted OR 2.66, 95% CI 0.75-9.48, p=0.132).
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