The Importance of Monocyte-to-High Density Lipoprotein-Cholesterol Ratio in Predicting Severity of Coronary Artery Disease in Acute Coronary Syndrome.

Background: Evaluating the association between coronary artery disease (CAD) severity and new inflammatory markers in acute coronary syndrome (ACS) is critical for managing the therapy procedure as well.

Aim: The primary goal of this study was to investigate the association between the monocyte-to-high density lipoprotein-cholesterol ratio (MHR), a novel inflammation marker, and the severity of CAD in patients with ACS.

Methods: The study was performed on ACS patients who were hospitalized for coronary angiography (CAG) in the coronary intensive care unit and was conducted with a retrospective design. The study comprised 344 patients (mean age 60.49 ± 12.23 years) with ACS who had CAG and laboratory testing. There were 212 patients with mild CAD according to the Synergy between percutaneous coronary intervention (PCI) with Taxus and Cardiac Surgery (SYNTAX) score (SYNTAX score ≤22) and 132 patients with severe CAD (SYNTAX score >22). The association between SYNTAX score, MHR, uric acid, the neutrophil-to-lymphocyte ratio (NLR), and other markers were assessed. All analyses were performed using SPSS 26.0.

Results: A modestly linear association was observed between MHR and SYNTAX score (r = 0.522, P < 0.001). Multivariate logistic regression analysis found male gender, high uric acid, high MHR, and NLR as possible individual predictors of SYNTAX score >22 in ACS. The receiver operating characteristic (ROC) analysis revealed that MHR 15.64 (AUC = 0.794; P < 0.001) could predict SYNTAX score >22 with higher sensitivity (81.8%) and specificity (78.3%).

Conclusions: The higher MHR independently predicts the severity of CAD in ACS. It may be a better parameter than the higher NLR and uric acid levels to predict CAD severity in ACS patients.