Apolipoprotein B/A1 Ratio for Predicting Major Adverse Cardiovascular Events in Coronary Artery Disease: Development and Validation of a Nomogram

Hongxu Zhu, Qi Jin Department of Cardiology, Beijing Haidian Hospital, Beijing, 100080, People’s Republic of ChinaCorrespondence: Qi Jin, Beijing Haidian Hospital, Haidian District, Zhongguancun Street, No. 29, Beijing, 100080, People’s Republic of China, Tel +86-13717725956, Email [email protected]: The apolipoprotein B to apolipoprotein A1 (ApoB/A1) ratio has emerged as a superior lipid marker for cardiovascular risk assessment. This study aimed to develop and validate a nomogram incorporating the ApoB/A1 ratio for predicting major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI).Methods: This retrospective cohort study included 2459 patients undergoing PCI, randomly allocated to training (n=1721) and validation (n=738) cohorts. LASSO regression and multivariable Cox regression were used for variable selection and model development. Model performance was evaluated using C-index, calibration curves, and decision curve analysis.Results: During a median follow-up of 33.8 months, MACE occurred in 187 patients (7.6%). The ApoB/A1 ratio was independently associated with MACE (HR 1.12 per 0.1 increase, 95% CI 1.06– 1.19, P< 0.001). The nomogram incorporating 10 predictors demonstrated good discrimination (C-index: 0.67 in training, 0.72 in validation) and calibration. Decision curve analysis confirmed superior clinical utility across threshold probabilities of 5%– 35%. Risk stratification showed distinct separation among low-, intermediate-, and high-risk groups, with 5-year MACE-free survival rates of 93.0%, 89.9%, and 83.1%, respectively (log-rank P< 0.001).Conclusion: The ApoB/A1 ratio may be an independent predictor of MACE in CAD patients after PCI. The developed nomogram showed promising performance for risk prediction and stratification in this retrospective cohort. External validation in prospective studies is warranted before clinical implementation.Keywords: apolipoproteins B, apolipoprotein A-I, coronary artery disease, percutaneous coronary intervention, nomograms, prognosis