[The relationship between NHR and coronary artery stenosis ≥50% in patients with controlled LDL-C]

Objective: To explore the correlation between neutrophil percentage to high-density lipoprotein cholesterol ratio (NHR) and coronary artery stenosis (CAS)≥50% in patients with controlled low-density lipoprotein cholesterol (LDL-C) <2.60 mmol/L. Methods: This study enrolled patients with controlled LDL-C who had been diagnosed with CAS disease at the Department of Cardiology, TEDA International Cardiovascular Hospital, between January and December 2013. Participants were stratified into two groups based on coronary angiography results: the CAS ≥50% group and the CAS <50% group. General clinical data, laboratory parameters, and NHR of patients were compared between the two groups. Logistic regression analysis was utilized to identify factors associated with CAS ≥50% in patients with controlled LDL-C. A receiver operating characteristic (ROC) curve was performed to evaluate the predictive value of these associated factors. The DeLong test was applied to compare the predictive efficacy among different models based on the ROC curves. Decision curve analysis (DCA) was employed to assess the benefits of the models in clinical decision-making. Results: A total of 467 subjects were enrolled, including 317 in the CAS ≥50% group and 150 in the CAS <50% group. The NHR in the CAS ≥50% group (67.15±20.31) was significantly higher than that in the CAS<50% group (58.24±17.59, t=4.615, P<0.001). Elevated NHR was an associated factor for CAS ≥50% with controlled LDL-C [OR=1.015, 95%CI: 1.003~1.027, P=0.016]. A ROC model integrating NHR, aspartate aminotransferase mitochondrial isoenzyme (ASTm), diabetes mellitus, and smoking history for predicting CAS≥50% in patients with controlled LDL-C had an area under the curve of 0.716, with a sensitivity of 61.50%, a specificity of 71.70%, and a Youden's index of 0.332. The DeLong test demonstrated that the integrated model exhibited significantly superior performance compared to the single NHR model (Z=3.765, P<0.001). Furthermore, DCA demonstrated that the integrated model can provide net benefits for clinical decision-making within a threshold probability range of 0.12~0.60. Conclusion: In patients with coronary artery lesions in whom LDL-C levels are controlled, elevated NHR is an associated factor for the occurrence of CAS≥50%. The model integrating NHR, ASTm, diabetes mellitus, and smoking history exhibits a certain predictive effect on disease.