Sini Fang, Huanting Liu, Youcheng Wang, Guangjie Wang, Yumeng Lei, Alian Wei, Xiyuan Mo, Liqiu Yan
A lower Hb/SCr ratio independently predicts increased long-term risks of CCM and ACM in patients with CAD and reduced kidney function after PCI. Given its modest discriminative ability, this readily available ratio may serve as a complementary marker for risk stratification rather than a standalone predictive tool, potentially helping to identify patients who warrant closer post-procedural surveillance.
OBJECTIVE: This investigation sought to assess the prognostic significance of the hemoglobin-to-serum creatinine (Hb/SCr) ratio for long-term survival among patients with coexisting coronary artery disease (CAD) and reduced kidney function after percutaneous coronary intervention (PCI).
METHODS: This retrospective study encompassed 2,310 patients who underwent PCI and had concomitant CAD and reduced kidney function. The cohort median Hb/SCr value of 1.60 was used as a pragmatic reference threshold to classify patients into low (<1.60) and high (≥1.60) Hb/SCr groups. The predictive significance of the Hb/SCr ratio regarding cardiac-cause mortality (CCM) and all-cause mortality (ACM) over a follow-up period of up to 60 months was evaluated employing Kaplan-Meier analysis and multivariable Cox proportional hazards models.
RESULTS: During 60 months of follow-up, 56 cardiac-cause deaths (2.4%) and 87 all-cause deaths (3.8%) occurred. Kaplan-Meier analysis showed significantly higher cumulative mortality in the low Hb/SCr group for both CCM (log-rank P = 0.002263) and ACM (log-rank P = 0.002349). The Hb/SCr ratio showed modest discrimination for CCM (AUC 0.663, 95% CI 0.585-0.742) and ACM (AUC 0.614, 95% CI 0.548-0.680). Compared with Hb/SCr < 1.60, Hb/SCr ≥ 1.60 was associated with lower adjusted risks of CCM (HR 0.49, 95% CI 0.27-0.90; P = 0.021) and ACM (HR 0.59, 95% CI 0.37-0.94; P = 0.028). Similar associations were observed when the ratio was analysed as a continuous variable (CCM: HR 0.28, 95% CI 0.14-0.57; ACM: HR 0.42, 95% CI 0.23-0.77).
CONCLUSION: A lower Hb/SCr ratio independently predicts increased long-term risks of CCM and ACM in patients with CAD and reduced kidney function after PCI. Given its modest discriminative ability, this readily available ratio may serve as a complementary marker for risk stratification rather than a standalone predictive tool, potentially helping to identify patients who warrant closer post-procedural surveillance.