Angiographic Severity of Coronary Artery Disease in Patients with STEMI in Bangladesh

Background: ST-elevation myocardial infarction (STEMI) is a major manifestation of coronary artery disease (CAD), and the extent of coronary involvement is an important indicator of disease severity. The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio may reflect an atherogenic lipid profile associated with greater coronary disease burden. Objective: To assess the angiographic severity of CAD using vessel and Gensini scores and determine its relationship with the TG/HDL-C ratio among patients with STEMI. Method: This cross-sectional observational study was conducted among 73 patients with STEMI at the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Bangladesh, from July 2019 to June 2021. Patients were categorized into high (≥4) and low (<4) TG/HDL-C groups. Coronary angiography was performed during hospitalization, and CAD severity was assessed using vessel and Gensini scores. Severe CAD was defined as a Gensini score >20. Data were analyzed using SPSS version 25.0. Results: The mean age was 51.03±10.47 years, and 84.9% were male. Chest pain was the predominant presenting symptom (98.6%). Hypertension was significantly more common in the high TG/HDL-C group than in the low-ratio group (66.0% vs. 34.8%, p=0.013). Mean Gensini score was significantly higher among patients with TG/HDL-C ≥4 than among those with <4 (39.4±24.29 vs. 11.34±7.37, p=0.0001). Severe CAD was present in 86.0% of patients with TG/HDL-C ≥4 compared with 8.7% of those with <4 (p=0.0001). Vessel involvement also differed significantly between groups (p=0.022). Conclusion: A higher TG/HDL-C ratio was strongly associated with greater angiographic severity and extent of CAD among patients with STEMI. The TG/HDL-C ratio may serve as a simple, readily available marker of severe coronary involvement.