Establishment and validation of a clinical nomogram model based on serum YKL-40 to predict major adverse cardiovascular events during hospitalization in patients with acute ST-segment elevation myocardial infarction.

The neutrophil to high-density lipoprotein cholesterol ratio (NHR) has been proposed as a potential marker for predicting cardiovascular events. However, its prognostic role following percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) remains unclear. This study aimed to evaluate the predictive value of NHR for left ventricular remodeling (LVR) and long-term outcomes in STEMI patients post-PCI. This retrospective study included 299 STEMI patients who underwent PCI and were followed for 24 months post-procedure. Echocardiography was performed upon admission and at 6 months post-myocardial infarction (MI). LVR was defined as an increase in left ventricular diastolic volume (LVEDV) of at least 20% from baseline. Based on their VR status, patients were divided into LVR (n = 81) and non-LVR (n = 218) groups and clinical data were compared. A weighted logistic regression model was used to study the correlation between NHR and LVR. Weighted Cox proportional risk models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for major adverse cardiovascular events (MACE). And the NHR was analyzed using receiver operating characteristic (ROC) curves to predict the occurrence of postoperative LVR and MACE in STEMI patients. Restricted cubic spline (RCS) analysis was used to explore the linear or non-linear relationship between NHR and LVR or MACE. Cox survival analysis was used to assess the relationship between NHR, LVR and survival time. Among the 299 STEMI patients enrolled in the study, LVR was observed in 81 patients after 24 months of follow-up. The LVR group had significantly higher NHR levels compared to the non-LVR group (8.19 ± 1.95 vs. 6.23 ± 1.91, P < 0.001). After adjusting for potential confounders, a significant positive correlation was found between NHR and LVR. Each standard deviation increase in NHR was associated with a 43% higher risk of MACE (HR: 1.43, 95% CI: 1.25-1.64, P < 0.001). ROC curve analysis demonstrated that NHR could predict both LVR (AUC: 0.762) and MACE (AUC: 0.722). An NHR cut-off value of >8.13 was significantly linked to an increased risk of MACE (HR: 4.30, 95% CI: 2.41-7.69). NHR is an independent predictor of LVR and MACE after PCI in STEMI patients. Monitoring NHR may aid in identifying high-risk patients early, facilitating individualized treatment.

Prognostic value of TIMI risk score combined with systemic immune-inflammation index and lipoprotein(a) in patients with ST-Segment elevation myocardial infarction after percutaneous coronary intervention.

Construction of a prediction model to predict the risk of major adverse cardiovascular events (MACE) in the long term after percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI). Retrospective analysis of STEMI patients treated with PCI from April 2018 to April 2021 in Fuyang People's Hospital. Lasso regression was used to screen the risk factors for the first occurrence of MACE in patients, and multifactorial logistic regression analysis was used to construct a prediction model. The efficacy was evaluated by area under the ROC curve (AUC), Hosmer-Lemeshow deviance test, calibration curve, clinical decision curve (DCA) and clinical impact curve (CIC). Logistic regression results showed that hypertension, diabetes mellitus, left main plus three branches lesion, estimated glomerular filtration rate and medication adherence were influential factors in the occurrence of distant MACE after PCI in STEMI patients ( P < 0.05). The AUC was 0.849 in the modeling group and 0.724 in the validation group; the calibration curve had a good fit to the standard curve, and the result of the Hosmer-Lemeshow test of deviance was x 2 = 7.742 ( P = 0. 459); the DCA and the CIC indicated that the predictive model could provide a better net clinical benefit for STEMI patients. A prediction model constructed from a total of five predictor variables, namely hypertension, diabetes, left main + three branches lesions, eGFR and medication adherence, can be used to assess the long-term prognosis after PCI in STEMI patients and help in early risk stratification of patients.

Emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) helps to reduce the occurrence of major adverse cardiovascular events (MACEs) such as death, cardiogenic shock, and malignant arrhythmia, but in-hospital MACEs may still occur after emergency PCI, and their mortality is significantly increased once they occur. The aim of this study was to investigate the risk factors associated with MACE during hospitalization after PCI in STEMI patients, construct a nomogram prediction model and evaluate its effectiveness. A retrospective analysis of 466 STEMI patients admitted to our hospital from January 2018 to June 2022. According to the occurrence of MACE during hospitalization, they were divided into MACE group (n = 127) and non-MACE group (n = 339), and the clinical data of the two groups were compared; least absolute shrinkage and selection operator (LASSO) regression was used to screen out the predictors with non-zero coefficients, and multivariate Logistic regression was used to analyze STEMI Independent risk factors for in-hospital MACE in patients after emergency PCI; a nomogram model for predicting the risk of in-hospital MACE in STEMI patients after PCI was constructed based on predictive factors, and the C-index was used to evaluate the predictive performance of the prediction model; the Bootstrap method was used to repeat sampling 1,000 Internal validation was carried out for the second time, the Hosmer-Lemeshow test was used to evaluate the model fit, and the calibration curve was drawn to evaluate the calibration degree of the model. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of the nomogram model and thrombolysis in myocardial infarction (TIMI) score in predicting in-hospital MACE in STEMI patients after acute PCI. The results of LASSO regression showed that systolic blood pressure, diastolic blood pressure, Killip grade II-IV, urea nitrogen and left ventricular ejection fraction (LVEF), IABP, NT-ProBNP were important predictors with non-zero coefficients, and multivariate logistic regression analysis was performed to analyze that Killip grade II-IV, urea nitrogen, LVEF, and NT-ProBNP were independent factors for in-hospital MACE after PCI in STEMI patients; a nomogram model for predicting the risk of in-hospital MACE after PCI in STEMI patients was constructed with the above independent predictors, with a C-index of 0.826 (95% CI: 0.785-0.868) having a good predictive power; the results of H-L goodness of fit test showed χ2 = 1.3328, P = 0.25, the model calibration curve was close to the ideal model, and the internal validation C-index was 0.818; clinical decision analysis also showed that the nomogram model had a good clinical efficacy, especially when the threshold probability was 0.1-0.99, the nomogram model could bring clinical net benefits to patients. The nomogram model predicted a greater AUC (0.826) than the TIMI score (0.696) for in-hospital MACE after PCI in STEMI patients. Urea nitrogen, Killip class II-IV, LVEF, and NT-ProBNP are independent factors for in-hospital MACE after PCI in STEMI patients, and nomogram models constructed based on the above factors have high predictive efficacy and feasibility.

Objective To examine the main adverse cardiovascular events that occur in individuals who have had an acute ST-segment elevation myocardial infarction (STEMI) after receiving percutaneous coronary intervention (PCI), such as serum C-type lectin domain family member 2 (CLEC2), serine protease inhibitor family member A3 (SERPINA3), and high-sensitivity C-reactive protein/albumin (hs-CRP/ALB) levels. Methods The STEMI group included 132 patients who were observed for a year after being hospitalized to the hospital between January 2023 and September 2024. The patients were divided into two groups: the MACE group and the non-MACE group, based on whether MACE came after PCI. Additionally, The control group consisted of 68 healthy people who were examined physically at the hospital throughout the same time period. Using an enzyme-linked immunosorbent test, the levels of serum CLEC2, SERPINA3, hs-CRP, and ALB were measured in each research participant, and the hs-CRP to ALB ratio was computed. After PCI, multivariate logistic regression was utilized to examine the variables affecting MACEs in STEMI patients. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of single and combined detection of serum CLEC2, SERPINA3, and hs-CRP/ALB for MACEs in STEMI patients after PCI. Results The incidence of MACE after PCI in 132 STEMI patients was 31.06% (41/132). The levels of serum CLEC2, SERPINA3 and hs-CRP/ALB in the STEMI group were significantly greater than those in the control group (P&lt;0.05). Independent risk factors for MACEs following PCI in STEMI patients included age ≥62 years, Killip grade ≥ grade III, cardiac troponin I level ≥1.7 ng/mL, CLEC2 level ≥155 pg/mL, SERPINA3 level ≥350 ng/L, and hs-CRP/ALB≥0.50 (P&lt;0.05), while left ventricular ejection fraction ≥50% was an independent protective factor. The area under the ROC curve (0.856) of the combined detection of serum CLEC2, SERPINA3, and hs-CRP/ALB for the prediction of MACEs in STEMI patients after PCI was greater than that of the individual detection of each index. Conclusion Serum CLEC2 levels ≥155 pg/mL, SERPINA3 levels ≥350 ng/L, and hs-CRP/ALB≥0.50 are closely related to the occurrence of MACEs in STEMI patients after PCI and can be used as auxiliary predictive indicators for the occurrence of MACEs in STEMI patients after PCI.

<i>Circulation: Cardiovascular Interventions</i> Editors’ Picks

The objective of the current study is to assess the usefulness of HbA1cAp ratio in predicting in-hospital major adverse cardiac events (MACEs) among acute ST-segment elevation myocardial infarction (STEMI) patients that have undergone percutaneous coronary intervention (PCI). Further, the study aims to construct a ratio nomogram for prediction with this ratio. The training cohort comprised of 511 STEMI patients who underwent emergency PCI at the Huaibei Miners’ General Hospital between January 2019 and May 2023. Simultaneously, 384 patients treated with the same strategy in First People’s Hospital of Hefei formed the validation cohort during the study period. LASSO regression was used to screen predictors of nonzero coefficients, multivariate logistic regression was used to analyze the independent factors of in-hospital MACE in STEMI patients after PCI, and nomogram models and validation were established. The LASSO regression analysis demonstrated that systolic blood pressure, diastolic blood pressure, D-dimer, urea, and glycosylated hemoglobin A1c (HbA1c)/apolipoprotein A1 (ApoA1) were significant predictors with nonzero coefficients. Multivariate logistic regression analysis was further conducted to identify systolic blood pressure, D-dimer, urea, and HbA1c/ApoA1 as independent factors associated with in-hospital MACE after PCI in STEMI patients. Based on these findings, a nomogram model was developed and validated, with the C-index in the training set at 0.77 (95% CI: 0.723–0.817), and the C-index in the validation set at 0.788 (95% CI: 0.734–0.841), indicating excellent discrimination accuracy. The calibration curves and clinical decision curves also demonstrated the good performance of the nomogram models. In patients with STEMI who underwent PCI, it was noted that a higher HbA1c of the ApoA1 ratio is significantly associated with in-hospital MACE. In addition, a nomogram is constructed having considered the above-mentioned risk factors to provide predictive information on in-hospital MACE occurrence in these patients. In particular, this tool is of great value to the clinical practitioners in determination of patients with a high risk.

Background: The increase in major adverse cardiovascular events (MACE) in patients with diabetes after primary percutaneous coronary intervention (pPCI) is significantly correlated with the admission blood glucose (ABG). However, it is unclear whether ABG in non-diabetic patients is related to MACE after pPCI. We aimed to explore the relationship between ABG and in-hospital MACE in non-diabetic ST-segment elevation myocardial infarction (STEMI) patients with Killip class I treated with pPCI. Methods: The Chinese STEMI pPCI Registry (NCT04996901) enrolled 5586 STEMI patients undergoing pPCI from January 2015 to August 2021. Patients were divided into three groups after excluding those with hyperglycemia (ABG ≥11 mmol/L) and a history of diabetes. MACE was defined by re-infarction, stroke, and cardiovascular death. The association between ABG and in-hospital MACE was assessed using Logistic regression analysis. Results: 2890 non-diabetic STEMI patients with Killip class I treated with pPCI were identified. Patients were divided into three groups based on ABG (Q1: 2.5–5.72 mmol/L; Q2: 5.73–7.0 mmol/L; Q3: 7.01–11.0 mmol/L). After multivariate adjustment for age, gender, Diastolic Blood Pressure (DBP), Heart Rate (HR), smoking, and hypertension, the OR of MACE in Q2 and Q3 were 1.43–1.62 times of Q1 in the calibration Model II to IV. Subgroup analysis showed that the OR of Q2 was 3.52-fold of Q1 in females and 1.54-fold in the elder (≥60 years). Sensitivity analysis showed that after excluding patients with ABG less than 4 mmol/L, elevated ABG was still associated with a significant increase in the risk of MACE. The area under the ROC curve of ABG in predicting the occurrence of MACE after pPCI was 0.668, and the C-index was 0.666. The cubic spline confirmed MACE risk decreased significantly with ABG below 6.3 mmol/L. Conclusions: Elevated ABG is associated with increased risk of in-hospital MACE in non-diabetic STEMI patients treated with pPCI, particularly females and the elderly. This retrospective observational study was registered in Clinical Trials (NCT04996901).

Background Acute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease that poses a great threat to the life and health of patients. Therefore, early diagnosis is important for STEMI patient treatment and prognosis. The purpose of this study was to investigate the value of serum YKL-40 and TNF-α in the diagnosis of STEMI. Methods From October 2020 to February 2022, 120 patients with STEMI were admitted to the Chest Pain Center of the Second People's Hospital of Hefei, and 81 patients with negative coronary angiography were selected as the control group. Serum YKL-40 and TNF-α concentrations were measured by sandwich ELISA. Pearson correlation was used to analyze the correlation between serum YKL-40, TNF-α, and serum troponin I (cTnI) in STEMI patients; multivariate logistic regression analysis was used to screen independent risk factors for STEMI. Three diagnostic models were constructed: cTnI univariate model (model A), combined serum YKL-40 and TNF-α model other than cTnI (model B), and combined cTnI and serum YKL-40 and TNF-α model (model C). We assessed the clinical usefulness of the diagnostic model by comparing AUC with decision curve analysis (DCA). Results Serum YKL-40 and TNF-α in the STEMI group were significantly higher than those in the control group (P < 0.001). On Pearson correlation analysis, there was a significant positive correlation between serum YKL-40, TNF-α, and cTnI levels in STEMI patients. Multivariate logistic regression analysis showed that serum YKL-40 and TNF-α were independent risk factors for the development of STEMI. The results of ROC analysis showed that the area under the curve (AUC) of serum YKL-40 for predicting the occurrence of STEMI was 0.704. The AUC of serum TNF-α for predicting the occurrence of STEMI was 0.852. The AUC of cTnI as a traditional model, model A, for predicting the occurrence of STEMI was 0.875. Model B predicted STEMI with an AUC of 0.851. The addition of serum YKL-40 and serum TNF-α to the traditional diagnostic model composed of cTnI constituted a new diagnostic model; that is, the AUC of model C for predicting the occurrence of STEMI was 0.930. Model C had a better net benefit between a threshold probability of 70–95% for DCA. Conclusion In this study, we demonstrate the utility of serum YKL-40 and TNF-α as diagnostic markers for STEMI and the clinical utility of diagnostic models by combining serum YKL-40 and TNF-α with cTnI.

Background Early risk stratification was strongly recommended to guide therapeutic management and to improve outcome for ST elevation myocardial infarction (STEMI) patients. Anaemia and high haemoglobin levels are common in STEMI patients, but the effect of the haemoglobin level on the prognosis of STEMI patients remains in dispute. The China Acute Myocardial Infarction registry-ST Elevation Myocardial Infarction (CAMI-STEMI) score can predict in-hospital mortality among Chinese STEMI patients, with similar performance to the well-established Thrombolysis in Myocardial Infarction (TIMI) score, while relying solely on simple and practical variables. This study aimed to evaluate the prognostic value of the haemoglobin level combined with the CAMI-STEMI score in STEMI patients after percutaneous coronary intervention (PCI). Methods We included 360 STEMI patients who underwent PCI. The patients were divided into 3 groups according to the first haemoglobin value after PCI, group 1 (male: Hb&lt;120 g/L, female: Hb&lt;110 g/L; 42 cases), group 2 (male: 120 g/L ≤ Hb&lt;160 g/L, female: 110 g/L≤Hb&lt;150 g/L; 278 cases), and group 3 (male: Hb ≥160 g/L, female: Hb ≥150 g/L; 40 cases). Clinical characteristics, and the incidence of major adverse cardiovascular and cerebral events (MACCE) during the follow-up period were recorded. Results The incidence of MACCE in the 3 groups increased with a decrease in the haemoglobin level. Multivariate regression analysis showed that the CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI and that anaemia was an independent predictor of MACCE incidence at 6 months and 1 year after PCI. A high haemoglobin level was an independent predictor of MACCE incidence at 1 year after PCI. The area under receiver operating characteristic curves (AUCs) of the haemoglobin level, CAMI-STEMI score and haemoglobin level combined with CAMI-STEMI score predicting the occurrence of MACCE in STEMI patients within 30 days after PCI were 0.604, 0.614, and 0.639, respectively. Figure 1. MACCE-free survival curve Conclusion The CAMI-STEMI score was an independent predictor of MACCE incidence at 30 days after PCI. The haemoglobin level combined with the CAMI-STEMI score improved the predictive value of MACCE in STEMI patients within 30 days after PCI. Acknowledgement/Funding This study was supported by grants to Chengchun Tang from the National Natural Science Foundation of China (Research Grant #81670237)

BackgroundCardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory, radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics, predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our center.MethodsThis was a retrospective, single-center study conducted at KAMC, Makkah during 2015–2020. All acute ST-segment elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS group.ResultsIn this study total 3074 acute ST-segment elevation myocardial infarction patients of which 132(4.3%) patients had CS. CS group tended to have higher ages than non-CS group. Pilgrims were more complicated by CS than nonpilgrims. Subsequently, CS patients had a highly significant (p < 0.001 for all) increase in the incidence of in-hospital complications including pulmonary oedema, cardiac arrest and ventilation. There was a significant increase in hospital stay length and in-hospital mortality among CS patients. Renal impairment, peak troponin level, haemoglobin drop≥3 gm/dl, and Left ventricular ejection fraction (EF) were significant independent predictors of cardiogenic shock among our patients. However, STEMI type, left main disease, and EF was the independent predictors of CS among our patients with diabetes with EF cut-off value of 35% with a sensitivity of 74.6% and a specificity of 65.3%. Age was the only independent predictor of mortality among CS patients. Though age, female gender, and diabetes were found to be the independent predictors for in-hospital mortality among our patients.ConclusionHigh-income middle eastern countries have comparable outcomes to Europe and USA among patients with acute ST-segment elevation myocardial infarction patients with higher improvement of medical care in the last 2 to 3 decades. Renal impairment, peak troponin, severe bleeding and ejection fraction were significant independent predictors of CS in acute ST-segment elevation myocardial infarction patients. However, STEMI type, left main disease, and ejection fraction were the independent predictors of CS in acute ST-segment elevation myocardial infarction patients with diabetes. Age was the only independent predictor of mortality among CS patients.

The incidence of major adverse cardiovascular events (MACE) following percutaneous coronary intervention (PCI) remains high among patients with acute ST-segment elevation myocardial infarction (STEMI). The Pan-Immune-Inflammation Value (PIV), an indicator of systemic inflammatory status, has demonstrated prognostic utility across multiple diseases and may serve as an indicator of risk of STEMI patients undergoing PCI. This study aimed to investigate the predictive value of PIV for MACE within one year following PCI in patients with acute STEMI. A retrospective analysis was conducted on 200 patients diagnosed with acute STEMI who underwent PCI at the Hainan General Hospital between January 2022 and December 2023. Based on the occurrence of MACE within one year post-PCI, patients were categorized into a MACE group (n = 148) and a non-MACE group (n = 52). Univariate and multivariate logistic regression analyses were conducted to identify factors influencing MACE occurrence in STEMI patients following PCI, and the predictive value of PIV was assessed using receiver operating characteristic (ROC) curve analysis. There were no statistically significant differences between groups in gender, smoking status, body mass index (BMI), red and white blood cell counts, Left Atrium Diameter (LAD), Left Ventricular End-Diastolic Diameter (LVDd), total protein, albumin, triglycerides (TG), and total cholesterol (TC) (p > 0.05). However, significant differences were observed in age, heart rate, left ventricular ejection fraction (LVEF), and PIV (p < 0.05). Multivariate logistic regression analysis identified age, heart rate, PIV, and LVEF as independent predictors of MACE within one year post-PCI in patients with STEMI (p < 0.05). ROC curve analysis showed that the predicted area under the curve (AUC) for PIV in predicting the occurrence of MACE was 0.866 (p < 0.001) (95% confidence interval (CI): 0.809-0.922), with a standard error of 0.029, and a Youden index of 0.62. At this threshold, the sensitivity was 77.70%, and the specificity was 84.60%. PIV demonstrates high predictive value for MACE within one year after PCI in patients with STEMI. It may serve as a valuable biomarker for assessing the risk of percutaneous coronary atherosclerosis events in this population. Further multi-center studies are warranted to validate its clinical utility.

Introduction: There have been various inflammatory markers implicated in the pathogenesis of Acute Coronary Syndromes (ACS). However, the role of the Neutrophil Lymphocyte Ratio (NLR) and Platelet Lymphocyte Ratio (PLR) as prognostic markers in ST-elevation Myocardial Infarction (STEMI) remains poorly researched. Aim: To determine the prognostic value of NLR and PLR to predict the immediate outcomes in patients with acute STEMI, and if any association exists between NLR/PLR and Thrombolysis in Myocardial Infarction (TIMI) risk score. Materials and Methods: This was a cross-sectional study conducted at a tertiary care centre, Puducherry, India, where 190 patients who presented to casualty with STEMI were enrolled. The patient co-morbidities, personal and family history were obtained. The routine laboratory parameters including platelets, lymphocytes, neutrophils and their corresponding ratios were calculated. Patients were grouped into low and high NLR/PLR groups and were assessed for occurrence of in-hospital mortality or Major Adverse Cardiovascular Events (MACE). Analysis was made to see if there is an association between NLR/PLR and MACE. Chi-square test and one-way ANOVA test was used for statistical significance. Results: Among 190 subjects, 157 male and 33 female with mean age of 55.72±11.24 years were included. A total of 8.94% patients 8.94% had MACE. NLR was positively associated with MACE (p-value=0.0006), whereas PLR was not associated with MACE. Patients with high NLR had 1.45 times higher odds of having MACE. NLR was significantly associated with TIMI risk score. Both NLR (F ratio=6.341) and PLR (F ratio=4.600) showed significant association with Killip classification, however NLR showed higher association (p-value &lt;0.001). Conclusion: NLR can be used as a powerful prognostic marker for predicting immediate MACE and death in STEMI patients. In addition, NLR showed positive correlation with Killip classification and TIMI risk score.

BackgroundAcute ST-segment elevation myocardial infarction (STEMI) is a serious cardiovascular disease. High thrombus burden is an independent risk factor for poor prognosis of acute myocardial infarction. However, there is no study on the correlation between soluble semaphorin 4D (sSema4D) level and high thrombus burden in patients with STEMI.PurposeThis study aimed to investigate the relationship between sSema4D level and the thrombus burden of STEMI and further explore its effect on the main predictive value of the occurrence of major adverse cardiovascular events (MACE).MethodsFrom October 2020 to June 2021, 100 patients with STEMI diagnosed in our hospital’s cardiology department were selected. According to the thrombolysis in myocardial infarction(TIMI)score, STEMI patients were divided into high thrombus burden groups (55 cases) and non-high thrombus burden groups (45 cases) 0.74 patients with stable coronary heart disease (CHD) were selected as stable CHD group, and 75 patients with negative coronary angiography (CAG) were selected as control group. Serum sSema4D levels were measured in 4 groups. The correlation between serum sSema4D and high-sensitivity C-reactive protein (hs-CRP) in patients with STEMI was analyzed. The relationship of serum sSema4D levels between the high and non-high thrombus burden group was evaluated. The effect of sSema4D levels on the occurrence of MACE was explored in one year after percutaneous coronary intervention.ResultsSerum sSema4D level was positively correlated with hs-CRP level in STEMI patients (P < 0.05) with a correlation coefficient of 0.493. The sSema4D level was significantly higher in the high versus non-high thrombus burden group (22.54(20.82,24.17), P < 0.05). Moreover, MACE occurred in 19 cases in high thrombus burden group and 3 cases in non-high thrombus burden group. The results of Cox regression analysis showed that sSema4D was an independent predictor of MACE (OR = 1.497,95% CI: 1.213–1.847, P < 0.001).ConclusionThe sSema4D level is associated with coronary thrombus burden and is an independent risk factor for MACE.

Neutrophil tohigh-density lipoprotein cholesterol ratio (NHR) has demonstrated predictive value for coronary artery disease (CAD). However, few research has been conducted on the predictive capacity of NHR for Major Adverse Cardiovascular Events (MACE) following Percutaneous Coronary Intervention (PCI) or the degree of coronary artery stenosis in hospitalized ST-segment elevation myocardial infarction (STEMI) patients. The study involved 486 patients diagnosed with STEMI between the years 2020 and 2023. Univariate and multivariate logistic regression analyses were conducted to evaluate the risk factors for MACE after PCI and severe coronary artery stenosis during hospitalization. Receiver operating characteristic (ROC) curves were generated to determine predictive power of NHR and MHR. Spearman correlation analysis was performed to assess the correlation between NHR, MHR and the Gensini score (GS). Multivariate logistic regression analysis showed that the NHR and MHR were the independent risk factor for MACE during hospitalization in STEMI patients (MHR: the odds ratio (OR)=2.347, 95% confidence interval (CI)=1.082-5.089, P=0.031) (NHR: OR=1.092, 95% CI=1.025-1.165, P=0.004). In addition, NHR was also an independent risk factor for high GS (NHR: OR=1.103, 95% CI=1.047-1.162, P<0.001), and the MHR was not an independent risk factor. The ROC curve analysis was performed to evaluate the predictive ability of NHR and MHR for in-hospital MACE in STEMI patients after primary PCI. The area under the curve (AUC) for NHR was 0.681. The AUC for MHR was 0.672. Regarding the prediction of high GS, the AUC for NHR was 0.649. The AUC for MHR was 0.587. Spearman correlation analysis showed that NHR exhibited stronger correlation with GS, while MHR was lower (NHR: r=0.291, P<0.001) (MHR: r=0.156, P<0.001). These findings highlight the potential clinical utility of NHR as a predictive indicator in STEMI patients after PCI during hospitalization, both for MACE events and the degree of coronary artery stenosis.