Predictive value of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio for in-stent restenosis after drug-eluting stent implantation in patients with coronary heart disease.

BACKGROUND & OBJECTIVE: In-stent restenosis (ISR) remains a major obstacle after drug-eluting stent (DES) implantation in patients with coronary heart disease (CHD), in which dyslipidemia play important roles. The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) have emerged as potential markers of both lipid metabolism and atherosclerosis. However, the association between NHHR and ISR after DES implantation in patients with CHD remains unclear. Consequently, the objective of this study was to determine the association between NHHR and ISR and its predictive value among CHD patients after DES implantation. METHODS: The clinical data of 496 patients with CHD who underwent DES implantation in the Department of Cardiology of the First People 's Hospital of Kashgar from January 2019 to December 2024 were collected. All patients completed postoperative follow-up, with a median follow-up time of 6 months. Patients were divided into three groups based on NHHR tertiles: Q1 (25th percentile), Q2 (50th percentile), and Q3 (75th percentile). Baseline characteristics were compared among groups. Restricted cubic spline (RCS) plots were used to explore the association between NHHR and ISR. Binary logistic regression analysis was performed to identify independent risk factors for ISR. Finally, receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of NHHR for ISR. RESULTS: There were significant differences in age, total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), stent length, number of stents and proportion of right coronary stent implantation in different NHHR groups (P < 0.05). RCS and logistic regression analyses revealed that NHHR and TC were independent risk factors for ISR (OR>1, P < 0.05). ROC curve analysis demonstrated that NHHR had superior predictive ability for ISR (AUC 0.702, 95% CI 0.630-0.775) compared to TC (AUC 0.639, 95% CI 0.564-0.714) and HDL-C (AUC 0.567, 95% CI 0.490-0.643). CONCLUSION: NHHR and TC are independent risk factors for ISR after DES implantation in CHD patients. Compared to traditional lipid markers TC and HDL-C, NHHR exhibits superior predictive value for ISR and may serve as a key clinical indicator for risk stratification.