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Platelet-to-Hemoglobin Ratio in Predicting Major Adverse Cardiovascular Events After Coronary Artery Bypass Grafting
Shanghao Chen1,2,3, Kefan Zhang1,2, Xuantao Liu1,2
1Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China.
Insights
The platelet-to-hemoglobin ratio (PHR) can predict major adverse cardiovascular events (MACE) after coronary artery bypass grafting (CABG). Elevated PHR is an independent predictor of MACE, improving risk prediction when combined with other factors.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Biomarkers
Background:
- Coronary artery bypass grafting (CABG) is standard for complex coronary artery disease (CAD).
- Predicting major adverse cardiovascular events (MACE) after CABG using hematologic markers is challenging.
- The platelet-to-hemoglobin ratio (PHR) shows potential as a prognostic marker in cardiovascular conditions.
Purpose of the Study:
- To investigate the prognostic value of the platelet-to-hemoglobin ratio (PHR) for predicting in-hospital and short-term adverse outcomes following CABG.
- To assess PHR's ability to predict 3-point MACE (cardiovascular death, myocardial infarction, stroke) post-CABG.
- To develop and validate a predictive nomogram incorporating PHR for MACE after CABG.
Main Methods:
- Retrospective cohort study of 1672 patients undergoing isolated CABG (2015-2021).
- PHR calculated as platelet count divided by hemoglobin.
- Primary endpoint: 3-point MACE (3P-MACE). Propensity matching and multivariate analysis were used. A predictive nomogram was developed and validated.
Main Results:
- Elevated PHR (≥1.890) was associated with increased likelihood of 3P-MACE and stroke.
- After propensity matching, 3P-MACE incidence was 5.7% in high PHR vs. 1.5% in low PHR group (P=0.010).
- Preoperative PHR was an independent predictor of 3P-MACE (OR: 1.800, P=0.026). Nomogram combining PHR improved AUC to 0.762.
Conclusions:
- Elevated preoperative PHR is independently associated with postoperative 3P-MACE after CABG.
- PHR reflects integrated risks of thrombosis and anemia.
- While PHR alone has modest predictive value, its inclusion in a multivariable nomogram significantly enhances MACE prediction accuracy.
Purpose:
Coronary artery bypass grafting (CABG) is widely recognized as the gold standard treatment for patients with complex coronary artery disease (CAD). The identification of reliable hematologic predictors for major adverse cardiovascular events (MACE) after CABG remains limited. In recent years, the platelet-to-hemoglobin ratio (PHR) has emerged as a promising prognostic marker in various cardiovascular conditions and malignancies. This study investigated the prognostic value of the PHR for predicting in-hospital and short-term adverse outcomes after CABG.
Patients And Methods:
This retrospective cohort study included 1672 Chinese patients who underwent isolated CABG surgery between 2015 and 2021. PHR was calculated as platelet count (×109/L) divided by hemoglobin (g/L). The primary endpoint was 3-point MACE (3P-MACE), including cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke during hospitalization. A predictive nomogram was developed and validated using bootstrap resampling.
Results:
In our study, individuals with elevated PHR levels were more likely to experience 3P-MACE and stroke. After propensity matching, the incidence of 3P-MACE was 5.7% in the high PHR group (PHR≥1.890) and 1.5% in the low PHR group (P = 0.010). Multivariate analysis identified preoperative PHR (odds ratio: 1.800 [95% CI 1.073-3.021], P=0.026) as an independent predictor for 3P-MACE post-CABG. A predictive nomogram for 3P-MACE following CABG was successfully developed. The predictive performance of PHR was comparable to NLR and PLR, with an area under the ROC curve (AUC) of 0.595 (95% CI 0.486-0.691). Combining PHR with nomogram parameters improved AUC to 0.762 (95% CI 0.687-0.837).
Conclusion:
Elevated PHR (≥1.890) was independently associated with postoperative 3P-MACE, reflecting the integrated effects of thrombosis and anemia risk. Although PHR demonstrated modest discrimination as a single variable, its integration into a multivariable nomogram improved predictive accuracy. These findings are hypothesis-generating and future multicenter, prospective validation studies are warranted.
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