Cholesterol, HDL, and glucose index and poor prognosis in acute coronary syndrome after PCI: a cohort study

Abstract Dysregulated serum lipids and hyperglycemia are established risk factors for adverse outcomes in acute coronary syndrome (ACS) patients after percutaneous coronary intervention (PCI). The Cholesterol, HDL, Glucose (CHG) index is a novel composite metric integrating glycemic and lipid profiles; however, its prognostic value in PCI-treated ACS remains undefined. A total of 23,508 ACS patients who underwent PCI were retrospectively analyzed. Participants were stratified by calculated CHG index. The primary endpoint was a composite of all-cause mortality, non-fatal myocardial infarction (MI), non-fatal stroke, and revascularization. Associations were evaluated using Cox regression models, restricted cubic spline (RCS), and subgroup analyses. During follow-up, 2311 participants (9.83%) experienced at least one adverse event. Compared to the low-CHG group, the high-CHG group had significantly higher rates of both the primary endpoint MACCE (11.24% vs. 8.42%, p < 0.001) and the secondary endpoint MACE (3.10% vs. 2.05%, p < 0.001). Multivariable Cox analysis indicated that a higher CHG index was independently associated with increased MACCE risk, whether as a continuous variable (HR 1.166, 95% CI 1.057–1.287) or categorical (HR 1.170, 95% CI 1.067–1.283). RCS analysis suggested a linear relationship with MACCE risk ( p for non-linearity = 0.633). Subgroup analyses demonstrated consistent associations between CHG index and MACCE across all strata, with no significant interactions observed (all P for interaction > 0.05). The CHG index demonstrates an independent and linear association with adverse outcomes in ACS patients undergoing PCI, suggesting its potential utility for risk stratification.