Plasma Atherogenic Index Predicts Malignant Arrhythmias in Non-STElevation Myocardial Infarction

Area of Science:

• Cardiology
• Biochemistry
• Clinical Medicine

Background:

• Malignant ventricular arrhythmias are significant complications of non-ST-elevation myocardial infarction (NSTEMI).
• The plasma atherogenic index (PAI), calculated from triglycerides and HDL cholesterol, reflects atherogenic dyslipidemia but its predictive role in NSTEMI arrhythmias is not well-established.

Purpose of the Study:

• To investigate whether the plasma atherogenic index independently predicts malignant ventricular arrhythmias in patients diagnosed with non-ST-elevation myocardial infarction.

Main Methods:

• Retrospective analysis of 502 NSTEMI patients (January 2024 - January 2025).
• Patients were stratified by arrhythmia occurrence and PAI tertiles.
• Logistic and Cox regression models were used to identify independent predictors of arrhythmias and mortality, respectively. ROC and Kaplan-Meier analyses assessed performance and survival.

Main Results:

• Malignant ventricular arrhythmias were observed in 9.4% of patients, with significantly higher PAI values compared to those without arrhythmias (0.48 ± 0.35 vs. 0.21 ± 0.29, P < .001).
• Multivariable analysis identified PAI as an independent predictor of both arrhythmias and short-term mortality (HR 1.342, P = .006).
• PAI demonstrated the highest discriminative value for arrhythmias (AUC 0.721) and mortality (AUC 0.709) with a cut-off of 0.32.

Conclusions:

• An elevated plasma atherogenic index is an independent predictor of malignant arrhythmias and short-term mortality in NSTEMI patients.
• As an accessible lipid marker, PAI may enhance risk stratification in high-risk NSTEMI populations.