Monocyte-to-High-Density Lipoprotein Cholesterol Ratio and Clinical Angiographic Risk Stratification in Patients with ST Segment Elevation Myocardial Infarction

Abstract

Background: The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) combines a pro-inflammatory cellular marker with an anti-inflammatory lipid marker and may reflect cardiovascular disease burden. Methods: This secondary analysis used the existing prospective observational cohort of 103 participants admitted to KIMS Hospital, Hubballi. Twenty-eight participants had normal coronary arteries and 75 had significant coronary angiographic disease. STEMI patients were categorized into low-risk (TIMI 0–2; n=27) and high-risk (TIMI ≥3; n=48) groups. Clinical, laboratory and angiographic variables were evaluated. Results: Mean MHR increased progressively from 1.7±0.05 in controls to 2.4±0.11 in low-risk STEMI and 3.3±0.03 in high-risk STEMI (p<0.001). Monocyte count increased while HDL-C decreased across the same groups. SVD predominated in the low-risk group (59.3%), whereas DVD predominated in the high-risk group (66.7%); TVD was present in 18.8% of high-risk patients (p<0.001). Conclusion: Higher MHR was associated with increasing clinical risk and a more extensive coronary angiographic disease pattern. MHR may be a useful adjunct to established risk assessment, although independent prognostic value requires prospective validation.

Keywords: STEMI; MHR; TIMI score; PCI; CAD; CAG; inflammation; multivessel coronary disease.