Neutrophil-to-HDL-C Ratio and Anatomically Significant Multivessel Disease Across Acute Coronary Syndrome Phenotypes.

OBJECTIVE: The neutrophil-to-high-density lipoprotein cholesterol ratio (NHR) is an emerging inflammatory-lipid biomarker. Whether NHR is associated with anatomically significant multivessel disease (MVD) across different acute coronary syndrome (ACS) phenotypes remains unclear. METHODS: We analyzed 421 consecutive ACS patients [268 with non-ST-segment elevation myocardial infarction (NSTEMI) and 153 with ST-segment elevation myocardial infarction (STEMI)] who underwent coronary angiography. Anatomically significant MVD was defined as ≥70% stenosis in at least two major epicardial coronary arteries, or ≥70% stenosis in one epicardial coronary artery in addition to ≥50% stenosis of the left main coronary artery. Receiver operating characteristic analysis and multivariable logistic regression were performed. RESULTS: Among NSTEMI patients, NHR predicted anatomically significant MVD with an area under the curve (AUC) of 0.694 [95% confidence inteval (CI): 0.630-0.757, p<0.001], using an optimal cut-off value of 0.1365 (78.0% sensitivity, 59.4% specificity). After multivariable adjustment, NHR remained independently associated with MVD (odds ratio: 5.870, 95% CI: 1.402-11.859, p<0.001). Among STEMI patients, NHR did not demonstrate discriminatory ability (AUC=0.481, p=0.690). In the overall ACS population, the NHR demonstrated modest discriminatory performance (AUC=0.615, p<0.001). CONCLUSIONS: NHR was associated with anatomically significant MVD mainly in patients with NSTEMI, whereas no meaningful discriminatory value was observed in patients with STEMI. This phenotype-specific finding suggests that NHR may better reflect the presence of MVD in NSTEMI than serve as a uniform marker across all ACS presentations.