Predictive value of the triglyceride-to-HDL cholesterol ratio in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Q: What are the key findings of this study?

Each unit increase in the TG/HDL-C ratio independently predicted a higher risk of repeat PCI (HR 1.21, 95% CI 1.02-1.43, p<0.05) in statin-treated ACS patients.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome undergoing primary percutaneous coronary intervention (n=431). Intervention: Baseline triglyceride-to-HDL cholesterol (TG/HDL-C) ratio (per unit increase or high ratio ≥1.85) vs. Low TG/HDL-C ratio (<1.85) or lower continuous TG/HDL-C values. Primary outcome: Repeat revascularization (repeat PCI) (HR 1.21, 95% CI 1.02-1.43, p=<0.05).

Q: What does this research mean for the field?

An increased triglyceride-to-HDL cholesterol (TG/HDL-C) ratio independently predicts a higher risk of repeat revascularization and major adverse cardiovascular events in statin-treated patients with acute coronary syndrome undergoing percutaneous coronary intervention. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To identify predictors of repeat percutaneous coronary intervention following an initial successful procedure in patients with acute coronary syndrome, focusing specifically on the triglyceride-to-HDL cholesterol ratio.

Vladimir Đorđević; Milan A Nedeljkovic

doi:10.5937/siks2601011q

January 1, 2026Srce i krvni sudoviOpen Access

Predictive value of the triglyceride-to-HDL cholesterol ratio in patients with acute coronary syndrome undergoing percutaneous coronary intervention

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Key result

Higher TG/HDL-C ratio linked to ~21% higher repeat PCI risk per unit increase in ACS.

HR 1.21
95% CI 1.02-1.43
P<0.05
n=431

Why the study?

A proportion of ACS patients undergoing PCI still require repeat revascularization despite advances in management, motivating an evaluation of predictors of repeat PCI with a focus on the TG/HDL-C ratio.

Does an elevated baseline triglyceride-to-HDL cholesterol (TG/HDL-C) ratio predict repeat percutaneous coronary intervention and one-year major adverse cardiovascular events in statin-treated patients with acute coronary syndrome undergoing primary PCI?

Key Points

To identify predictors of repeat percutaneous coronary intervention following an initial successful procedure in patients with acute coronary syndrome, focusing specifically on the triglyceride-to-HDL cholesterol ratio.
Retrospective analysis of 431 statin-treated acute coronary syndrome patients who underwent primary percutaneous coronary intervention between 2021 and 2024, followed by surveillance coronary angiography 6–12 months later.
Patients were stratified by the median triglyceride-to-HDL cholesterol ratio cutoff of 1.85 (low ratio n=214; high ratio n=217) and by the occurrence of repeat revascularization.
Univariable and multivariable Cox proportional hazards regression models evaluated predictors of repeat intervention and adverse cardiovascular outcomes.
Repeat percutaneous coronary intervention occurred in 203 patients, with both the triglyceride-to-HDL cholesterol ratio (HR=1.21; 95% CI: 1.01-1.43; p<0.05) and the Gensini score (HR=1.01; 95% CI: 1.00-1.02; p<0.001) remaining independent predictors in multivariable analysis.
Patients in the high triglyceride-to-HDL cholesterol group experienced significantly higher rates of major adverse cardiovascular events (18.32% vs. 11.88%; HR=1.54; 95% CI: 1.24-1.91; p<0.001), target lesion revascularization (12.69% vs. 8.86%; HR=1.43; 95% CI: 1.10-1.86; p<0.01), and stent thrombosis (2.76% vs. 1.35%; HR=2.04; 95% CI: 1.06-3.93; p<0.05) at one-year follow-up.

Study Design

Type

Cohort (n=431)

Multicenter

No

Structured PICO

Does an elevated baseline triglyceride-to-HDL cholesterol (TG/HDL-C) ratio predict repeat percutaneous coronary intervention and one-year major adverse cardiovascular events in statin-treated patients with acute coronary syndrome undergoing primary PCI?

P

Population

431 statin-treated adults with acute coronary syndrome (mean age 64 years, 23.9% female) undergoing first-ever successful primary PCI with stent implantation at a single center in Serbia, followed for 12 months with control coronary angiography at 6–12 months.

E

Exposure

Elevated baseline triglyceride-to-HDL cholesterol (TG/HDL-C) ratio (stratified by median cutoff value 1.85 into high-ratio group n=217, and analyzed as a continuous variable per unit increase). All patients received dual antiplatelet therapy (aspirin 300 mg loading / 100 mg daily maintenance plus clopidogrel or ticagrelor) and statin therapy over 12 months.

C

Comparator

Low baseline TG/HDL-C ratio (<1.85, n=214) on the same background secondary prevention therapy (dual antiplatelet therapy, beta-blockers, ACEi/ARBs, and statins).

O

Outcome

Repeat revascularization (repeat PCI, including target lesion revascularization [TLR], target vessel revascularization [TVR], and de novo revascularization [DVR]) assessed over 12 months of follow-up (with control coronary angiography at 6–12 months).hard clinical

Main Result

Hazard Ratio: 1.21 (95% CI 1.02–1.43)

p-value: p=<0.05

In statin-treated ACS patients undergoing successful initial PCI, an elevated baseline TG/HDL-C ratio independently predicts repeat revascularization and 1-year MACE, offering a simple, accessible biomarker to identify patients needing intensified secondary prevention.

Limitations

Retrospective design introduces potential for selection bias
Single-center study with a relatively modest sample size, limiting generalizability
Follow-up period was limited to one year
Some potentially relevant confounding factors influencing repeat revascularization were not systematically assessed
Single-center study with a relatively modest sample size limiting generalizability
Follow-up period limited to one year
Some potentially relevant confounding factors influencing repeat revascularization were not systematically assessed in all patients

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Implication

TG/HDL-C ratio was associated with repeat PCI in statin-treated ACS; leaves open its role in risk stratification pending prospective validation.

Abstract

Background. Despite advances in the management of acute coronary syndrome (ACS), a proportion of patients undergoing percutaneous coronary intervention (PCI) require repeat revascularization. This study aimed to identify predictors of repeat PCI after first successful intervention, with a particular focus on the triglyceride-to-HDL cholesterol (TG/HDL-C) ratio. Methods. This retrospective study included 431 statin-treated ACS patients who underwent primary PCI between 2021 and 2024, followed by control coronary angiography 6-12 months later. Patients were stratified by the median TG/HDL-C ratio (1.85) and by the occurrence of repeat PCI. Uniand multivariable Cox proportional hazards models were applied. Results. Repeat PCI occurred in 203 patients. The TG/HDL-C ratio (HR=1.21; 95% CI: 1.01-1.43; p<0.05) and the Gensini score (HR=1.01; 95% CI: 1.00-1.02; p<0.001) were independent predictors of repeat revascularization. Higher TG/HDL-C ratios were associated with increased rates of target lesion revascularization, stent thrombosis, and major adverse cardiovascular events during one-year follow-up. Conclusion. The TG/HDL-C ratio and Gensini score are valuable, easily accessible predictors of repeat PCI and adverse cardiovascular outcomes in ACS patients after first successful PCI.

Discussion

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Cite This Study

Đorđević et al. (2026) conducted a cohort in Acute coronary syndrome undergoing primary percutaneous coronary intervention (n=431). Baseline triglyceride-to-HDL cholesterol (TG/HDL-C) ratio (per unit increase or high ratio ≥1.85) vs. Low TG/HDL-C ratio (<1.85) or lower continuous TG/HDL-C values was evaluated on Repeat revascularization (repeat PCI) (HR 1.21, 95% CI 1.02-1.43, p=<0.05). Each unit increase in the TG/HDL-C ratio independently predicted a higher risk of repeat PCI (HR 1.21, 95% CI 1.02-1.43, p<0.05) in statin-treated ACS patients.

synapsesocial.com/papers/6af3463ebdf2424ebd04f7e0 https://doi.org/10.5937/siks2601011q

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Predictive value of the triglyceride-to-HDL cholesterol ratio in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Predictive value of the triglyceride-to-HDL cholesterol ratio in patients with acute coronary syndrome undergoing percutaneous coronary intervention

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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