Abstract

Background: Non-HDL-cholesterol reflects the overall burden of atherogenic lipoproteins and may be associated with the severity of coronary artery lesions in patients with acute coronary syndrome. This study aimed to describe serum non-HDL-cholesterol levels and evaluate their association with hs-CRP, hs-Troponin T, and the severity of coronary artery disease.

Methods: A cross-sectional descriptive study was conducted on 127 patients with acute coronary syndrome treated at the Interventional Cardiology Emergency Department, Cardiovascular Center, Hue Central Hospital, from May 2024 to May 2025. Clinical characteristics, laboratory findings, lipid profiles, hs-CRP, hs-Troponin T, and coronary angiographic features were collected. The severity of coronary artery lesions was assessed using the Gensini score, SYNTAX I score, and SYNTAX II score.

Results: The mean age was 69.8 ± 11.4 years, and 59.1% of patients were male. Hypertension was the most common cardiovascular risk factor, accounting for 74.8%. The mean non-HDL-C level was 3.9 ± 1.4 mmol/L, and elevated non-HDL-C was observed in approximately 65% of both male and female patients. Multivessel coronary artery disease was common, with three-vessel disease accounting for 39.4% and two-vessel disease for 29.9%. Non-HDL-C increased with Gensini score severity and showed a weak positive correlation with the Gensini score (r = 0.21; p = 0.020). Non-HDL-C showed moderate predictive value for intermediate-to-high Gensini score (AUC = 0.634; p = 0.010) and ≥2-vessel coronary artery disease (AUC = 0.658; p = 0.005). However, no significant association was found between non-HDL-C and SYNTAX I or SYNTAX II scores.

Conclusion: Serum non-HDL-C was frequently elevated in patients with acute coronary syndrome and was associated with hs-Troponin T, Gensini score, and multivessel coronary artery disease. Non-HDL-C may be useful for assessing atherosclerotic burden and residual lipid-related risk, but it cannot replace anatomical scoring systems in evaluating coronary lesion severity.