Serum atherogenic index and lipid ratios as predictors of in-hospital major adverse cardiovascular events in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

Introduction: Coronary heart disease (CHD) has been recognized as a leading cause of death globally. The mortality rate of ST elevation myocardial infarction (STEMI) patients is 6-14% of the total deaths of acute coronary syndrome patients and as much as 30% of STEMI mortality occurs within 24-48 hours post symptom onset. To date, percutaneous coronary intervention (PCI) has been the primary management procedure for STEMI. However, various factors are known to influence major cardiovascular events (MACEs) which are associated with patient prognosis. Atherogenic index of plasma (AIP) and lipid ratios (non-HDL-C and LDL-C/HDL-C ratio) are novel markers that can be used as predictors of cardiovascular disease. This study aims to determine whether AIP and lipid ratios can be used as predictors of MACEs during hospitalization in STEMI patients after reperfusion with primary PCI. Methods: This study was a retrospective cohort study located at Prof. Dr. I.G.N.G. Ngoerah Hospital, Denpasar, Bali and conducted for 20 weeks. Determination of research subjects and sampling was done consecutively according to the inclusion and exclusion criteria. Blood samples were taken when the patient was admitted to the emergency department and the patient was assessed for MACEs after primary PCI during hospitalization. The collected data were analyzed with SPSS for windows version 26.0. Results: There were 45 people who experienced MACE in this study and 26 others did not experience MACE. AIP (0.49 ± 0.29 Vs. 0.38 ± 0.24), non-HDL-C (141.11 ± 5.73 Vs. 107.23 ± 27.62), and LDL-C/HDL-C ratio (3.76 ± 0.25 Vs. 2.19 ± 0.62) values were higher in the group that experienced MACE compared to those without MACE (p<0.05). Non-HDL-C and LDL-C/HDL-C ratio showed AUC values >0.7 (p<0.05). Multivariate analysis showed that high non-HDL-C (Adjusted HR 1.12; 95% CI 0.61-2.03; p=0.025) and LDL-C/HDL-C ratio (Adjusted HR 4.51; 95% CI 1.94-10.46; p<0.001) were the most important variables for the incidence of MCI during hospitalization. Conclusion: This study shows that high non-HDL-C values and high LDL-C/HDL-C ratio are predictors of hospitalized MACE in patients with AMI after primary PCI.