Abstract

Objective:  To evaluate the association between non-HDL-C/HDL-C and coronary lesion severity in patients undergoing PCI.

Methods: This cross-sectional study included 135 patients with confirmed coronary artery disease who underwent coronary angiography and had an indication for PCI at Hue Central Hospital (May 2024-August 2025). The non-HDL-C/HDL-C ratio was calculated from lipid profiles. Lesion severity was evaluated using Gensini, SYNTAX I, and SYNTAX II scores. ROC analysis assessed discrimination for moderate-to-severe lesions, and multivariable logistic regression identified independent associations.

Results: The mean non-HDL-C/HDL-C ratio was 3.748 ± 1.40 and did not differ between acute and chronic coronary syndromes (p = 0.361). The ratio increased across Gensini categories (p = 0.023), showed no difference across SYNTAX I categories (p = 0.773), but differed across SYNTAX II categories (p = 0.003). For predicting moderate-to-severe lesions, the ratio showed modest performance (AUC 0.618, 95% CI 0.523 - 0.713, p = 0.020) with a cut-off of 4.477 (sensitivity 36.3%, specificity 85.5%). In multivariable analysis, non-HDL-C/HDL-C remained independently associated with moderate-to-severe lesions (OR 1.405, 95% CI 1.065 - 1.855, p = 0.016).

Conclusions: A higher non-HDL-C/HDL-C ratio was associated with greater coronary lesion severity (notably by Gensini) and independently predicted moderate-to-severe lesions in PCI patients.